Basic Information
| Provider Information | |||||||||
| NPI: | 1457899494 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DAVID A SACK MD A PROFESSIONAL MEDICAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ELEMENTS MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 671387 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752671387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155677282 | ||||||||
| FaxNumber: | 6152618912 | ||||||||
| Practice Location | |||||||||
| Address1: | 20725 ROCKCROFT DR | ||||||||
| Address2: | |||||||||
| City: | MALIBU | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902655343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103179233 | ||||||||
| FaxNumber: | 3109430438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2017 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | MAPLESDEN | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR DIRECTOR RCM | ||||||||
| AuthorizedOfficialTelephone: | 6155103078 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPC, CHC, CHPC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | 20A13416 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
No ID Information.