Healthcare Provider Details

I. General information

NPI: 1609871235
Provider Name (Legal Business Name): EVAN SPENCER TARAGANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 11/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W SUNSET BLVD 4TH FLOOR DEPT OF PEDIATRICS
LOS ANGELES CA
90027-6082
US

IV. Provider business mailing address

4700 W SUNSET BLVD 4TH FLOOR DEPT OF PEDIATRICS
LOS ANGELES CA
90027-6082
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-7234
  • Fax:
Mailing address:
  • Phone: 323-783-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38756
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: