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General NPI Number Information
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NPI Number | 1184652760
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Entity Type | Individual
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Provider Name | ALEXANDER POPOV
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 12512 VICTORY BLVD #D
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3180
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Country | US
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Telephone | 818-753-9994
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Fax | 818-753-8621
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Provider Business Mailing Address
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Address Line | 12512 VICTORY BLVD #D
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3180
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Country | US
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Telephone | 818-753-9994
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Fax | 818-753-8621
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A78244
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License Number State | CA
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