Provider Demographics
NPI:1356103568
Name:SIPOVA, STEPANKA (CMT, NMT)
Entity type:Individual
Prefix:
First Name:STEPANKA
Middle Name:
Last Name:SIPOVA
Suffix:
Gender:F
Credentials:CMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14355 HUSTON ST APT 215
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1822
Mailing Address - Country:US
Mailing Address - Phone:323-485-6549
Mailing Address - Fax:
Practice Address - Street 1:14355 HUSTON ST APT 215
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1822
Practice Address - Country:US
Practice Address - Phone:323-485-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist