Provider Demographics
NPI:1861554099
Name:SOUTH BAY SPORTS AND PREVENTIVE MEDICINE ASSOCIATES, INC.
Entity type:Organization
Organization Name:SOUTH BAY SPORTS AND PREVENTIVE MEDICINE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAGLIMBENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-293-7767
Mailing Address - Street 1:900 LAFAYETTE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4966
Mailing Address - Country:US
Mailing Address - Phone:408-293-7677
Mailing Address - Fax:408-294-6595
Practice Address - Street 1:900 LAFAYETTE ST STE 105
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050
Practice Address - Country:US
Practice Address - Phone:408-293-7767
Practice Address - Fax:408-294-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54870207RS0010X
CAG84807207R00000X
CAG73977207RS0010X
CACAA055048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62312Medicare UPIN
CA00G739772Medicare PIN
G59273Medicare UPIN
CA00A550481Medicare PIN
G84956Medicare UPIN
CA00A548703Medicare PIN
F74282Medicare UPIN
CA00G848071Medicare PIN