Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A5717 | CA |
NPI | 1659998946 |
---|---|
Provider Name | Mr. Stefan Hagopian |
First Address | Santa Monica, CA 90404 |
Second Address | Santa Monica, CA 90404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2020 |
Last Update Date | 02/07/2020 |