Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G29700 | CA |
N | 111NI0900X | Internist | G29700 | CA |
Y | 207RH0000X | Hematologist | G29700 | CA |
NPI | 1184731135 |
---|---|
Provider Name | Mr. Stephen Forman |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A44121 | (02) | |
OOG297000 | (05) | CA |