Provider Demographics
NPI:1023108925
Name:POPOVA, STELLA (MD)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:POPOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7256 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3410
Mailing Address - Country:US
Mailing Address - Phone:323-654-7716
Mailing Address - Fax:323-654-7771
Practice Address - Street 1:7258 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-3410
Practice Address - Country:US
Practice Address - Phone:323-654-7716
Practice Address - Fax:323-654-7771
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A655990Medicaid
CA00A655990Medicaid
CA00A655991Medicare ID - Type Unspecified