Provider Demographics
NPI:1093978785
Name:KAPPEL, STEFANI T (MD,)
Entity Type:Individual
Prefix:DR
First Name:STEFANI
Middle Name:T
Last Name:KAPPEL
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:CHS 52-121
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-5420
Mailing Address - Fax:
Practice Address - Street 1:2020 SANTA MONICA BLVD
Practice Address - Street 2:510
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-917-3376
Practice Address - Fax:310-582-6302
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2011-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA105498207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093978785Medicaid
CA1093978785Medicaid