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NPI Code Detail

MEDICARE: DR. EVLYNE HERSEL

MEDICARE:  DR. EVLYNE  HERSEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist59814CA

General Provider Information

NPI Number : 1013212919
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EVLYNE HERSEL
Provider Business Mailing Address
First Line : 1627 CAMDEN AVE
Second Line : APT #305
City : LOS ANGELES
State : CA
Zip : 90025-3547
Country : US
Telephone Number : 310-429-8043
Fax Number : 310-444-7119
Provider Business Practice Location Address
First Line : 1627 CAMDEN AVE
Second Line : APT #305
City : LOS ANGELES
State : CA
Zip : 90025-3547
Country : US
Telephone Number : 310-429-8043
Fax Number : 310-444-7119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2011
Last Update Date : 01/24/2011

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