Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | D0086197 | MD |
Y | 207QA0401X | Family Doctor - Addiction Medicine | A167956 | CA |
NPI | 1033596143 |
---|---|
Provider Name | Alexander Pappas |
First Address | Venice, CA 90291-2767 |
Second Address | Venice, CA 90291-2767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2015 |
Last Update Date | 03/03/2021 |