Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | A142146 | CA |
NPI | 1134485741 |
---|---|
Provider Name | Elizabeth Blake Sasso |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90015-3068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 07/09/2020 |