Provider Demographics
NPI:1073807087
Name:KOVAL, MICHELLE STEPHANIE (RPA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:STEPHANIE
Last Name:KOVAL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 N CRESCENT DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4860
Mailing Address - Country:US
Mailing Address - Phone:310-246-0702
Mailing Address - Fax:310-246-0672
Practice Address - Street 1:415 N CRESCENT DR
Practice Address - Street 2:SUITE 140
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4860
Practice Address - Country:US
Practice Address - Phone:310-246-0702
Practice Address - Fax:310-246-0672
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA21238363A00000X
NY014309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant