Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A162065 | CA |
Y | 207NS0135X | Procedural Dermatology | A162065 | CA |
NPI | 1295153997 |
---|---|
Provider Name | Sara Ruth Hogan |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Long Beach, CA 90808-1793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 22/10/2020 |