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NPI Code Detail

MEDICARE: MS. LIV S. HAGSTROM PA-C

MEDICARE: MS. LIV S. HAGSTROM PA-C
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
1363AS0400XSurgical Physician AssistantPA10004777WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811986672
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LIV S. HAGSTROM PA-C
Provider Business Mailing Address
First Line : 75 FRANCIS ST
Second Line : CARDIOVASCULAR DIVISION
City : BOSTON
State : MA
Zip : 02115-6110
Country : US
Telephone Number : 617-733-9667
Fax Number :
Provider Business Practice Location Address
First Line : 2121 SANTA MONICA BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2303
Country : US
Telephone Number : 310-829-8618
Fax Number : 310-829-8607
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 04/13/2021

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