Provider Demographics
NPI:1356437297
Name:SHOUPE, DONNA (MD)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:SHOUPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:SHOUPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5955
Mailing Address - Fax:323-442-5714
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5955
Practice Address - Fax:323-442-5714
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36864207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABN0482OtherMEDICARE PTAN
CAA46839Medicare UPIN