Individual
MS. LIV S. HAGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2121 SANTA MONICA BLVD, SANTA MONICA, CA 90404-2303
(310) 829-8618
(310) 829-8607
Mailing address
75 FRANCIS ST, CARDIOVASCULAR DIVISION, BOSTON, MA 02115-6110
(617) 733-9667
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10004777
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8413650
—
WA
Enumeration date
10/14/2005
Last updated
04/13/2021
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