Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 142147 | CA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | A142147 | CA |
NPI | 1063863942 |
---|---|
Provider Name | Dr. Stephen Speicher |
First Address | Los Angeles, CA 90027-6062 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 05/11/2020 |