Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | G36864 | CA |
NPI | 1356437297 |
---|---|
Provider Name | Mrs. Donna Shoupe |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46839 | (02) | CA |