Provider Demographics
NPI:1609871235
Name:TARAGANO, EVAN SPENCER (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:SPENCER
Last Name:TARAGANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 W SUNSET BLVD
Mailing Address - Street 2:4TH FLOOR DEPT OF PEDIATRICS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6082
Mailing Address - Country:US
Mailing Address - Phone:323-783-7234
Mailing Address - Fax:
Practice Address - Street 1:4700 W SUNSET BLVD
Practice Address - Street 2:4TH FLOOR DEPT OF PEDIATRICS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6082
Practice Address - Country:US
Practice Address - Phone:323-783-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15634884Medicaid
CO15634884Medicaid