Provider Demographics
NPI:1245558204
Name:DAGMAR LIEPA, MD
Entity type:Organization
Organization Name:DAGMAR LIEPA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:I
Authorized Official - Last Name:LIEPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-904-9008
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91408-0052
Mailing Address - Country:US
Mailing Address - Phone:818-904-9008
Mailing Address - Fax:818-994-4491
Practice Address - Street 1:14407 HAMLIN ST STE A
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6200
Practice Address - Country:US
Practice Address - Phone:818-904-9008
Practice Address - Fax:818-994-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty