Individual
DR. STACEY EDWIN PODKOVIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4650 W SUNSET BLVD, LOS ANGELES, CA 90027-6062
(323) 660-2450
Mailing address
3250 WILSHIRE BLVD STE 1101, LOS ANGELES, CA 90010-1513
(323) 361-3550
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
20A16756
CA
207T00000X
Neurological Surgery Physician
OS20696
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128226900
—
FL
Enumeration date
05/02/2017
Last updated
12/10/2025
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