Healthcare Provider Details

I. General information

NPI: 1952872863
Provider Name (Legal Business Name): STEPHANIE YAGI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

1704 PINTO LN
LAS VEGAS NV
89106-4197
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberDO3172
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: