Provider Demographics
NPI:1194322768
Name:SAGE, OLIVIA (LAC DIPLAC)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:
Last Name:SAGE
Suffix:
Gender:F
Credentials:LAC DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29862 N TATUM BLVD APT 2069
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-2379
Mailing Address - Country:US
Mailing Address - Phone:602-596-9428
Mailing Address - Fax:
Practice Address - Street 1:29834 N CAVE CREEK RD STE 110
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-2384
Practice Address - Country:US
Practice Address - Phone:602-596-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC010121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist