Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | G41053 | CA |
NPI | 1306958517 |
---|---|
Provider Name | Scott Michael Eisenkop |
First Address | Tarzana, CA 91356 |
Second Address | Agoura Hills, CA 91301-4233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 28/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G410530 | (05) | CA |
00G410530 | BLUE SHIELD (01) | |
A48441 | (02) |