Individual
STEPHANIE CHANNUAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
757 WESTWOOD PLZ # 1633LO, LOS ANGELES, CA 90095-8358
(949) 230-5118
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A117770
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2011
Last updated
11/30/2021
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