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NPI Code Detail

MEDICARE: STACY M. HASEGAWA

MEDICARE:   STACY M. HASEGAWA
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1770605107
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY M. HASEGAWA
Provider Business Mailing Address
First Line : 3200 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3740
Country : US
Telephone Number : 310-836-1223
Fax Number :
Provider Business Practice Location Address
First Line : 3200 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3740
Country : US
Telephone Number : 310-836-1223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2007
Last Update Date : 02/20/2020

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Directions to “ STACY M. HASEGAWA ” Practice Location

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