Provider Demographics
NPI:1124066360
Name:SAGER, SUSANNE (MD)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:SAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 MEDICAL CENTER DR. #300
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1973
Mailing Address - Country:US
Mailing Address - Phone:818-593-5439
Mailing Address - Fax:818-593-3460
Practice Address - Street 1:7301 MEDICAL CENTER DR. #300
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1973
Practice Address - Country:US
Practice Address - Phone:818-593-5439
Practice Address - Fax:818-593-3460
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG632002080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08608FMedicaid
CAZZT40394FMedicaid
CA050394OtherBLUE CROSS
CAG63200OtherMEDICAL BOARD OF CA
CARHM08609FMedicaid
CARHM18553HMedicaid
CA050394Medicare ID - Type UnspecifiedMEDICARE
CA058609Medicare ID - Type UnspecifiedRH MEDICARE
CARHM08609FMedicaid
CAZZT40394FMedicaid
CAZZT40394FMedicaid