Healthcare Provider Details

I. General information

NPI: 1093978785
Provider Name (Legal Business Name): STEFANI T KAPPEL M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD 510
SANTA MONICA CA
90404
US

IV. Provider business mailing address

10833 LE CONTE AVE CHS 52-121
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-917-3376
  • Fax: 310-582-6302
Mailing address:
  • Phone: 310-825-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA105498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: