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General NPI Number Information
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NPI Number | 1053632430
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Entity Type | Individual
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Provider Name | PHILIPPE CHAMPAGNE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2010
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 757 WESTWOOD PLZ STE 7501
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City | LOS ANGELES
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State | CA
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Zip | 90095-1736
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Country | US
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Telephone | 310-825-9111
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 16TH ST SUITE 125
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City | SANTA MONICA
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State | CA
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Zip | 90404-1235
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Country | US
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Telephone | 310-315-8900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A119139
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A119139
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License Number State | CA
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