Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A16677 | CA |
NPI | 1003342023 |
---|---|
Provider Name | Dr. Olympia Alexandra Kabobel |
First Address | Los Angeles, CA 90015-3010 |
Second Address | Compton, CA 90220-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 19/10/2020 |