Basic Information
| Provider Information | |||||||||
| NPI: | 1720194129 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACH PHYSICIAN BILLING TRUST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8816 FOOTHILL BLVD | ||||||||
| Address2: | SUITE 103-322 | ||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917307199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094842865 | ||||||||
| FaxNumber: | 9099416974 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094842865 | ||||||||
| FaxNumber: | 9099416974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | TRIGUEROS | ||||||||
| AuthorizedOfficialFirstName: | LOURDES | ||||||||
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| AuthorizedOfficialTitleorPosition: | TRUSTEE | ||||||||
| AuthorizedOfficialTelephone: | 9092626125 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | ZZZ5184Z | 01 | CA | BLUE SHIELD GROUP NUMBER | OTHER |