Provider Demographics
NPI:1114774098
Name:SALLY DAGANZO, MD INC
Entity type:Organization
Organization Name:SALLY DAGANZO, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGANZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD MA FACP
Authorized Official - Phone:415-249-2580
Mailing Address - Street 1:1050 NORTHGATE DR STE 500
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2542
Mailing Address - Country:US
Mailing Address - Phone:415-249-2580
Mailing Address - Fax:415-728-0375
Practice Address - Street 1:1050 NORTHGATE DR STE 500
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2542
Practice Address - Country:US
Practice Address - Phone:415-249-2580
Practice Address - Fax:415-728-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty