Liv S. Hagstrom, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA10004777 Issued in WA

Practice address

2121 Santa Monica Blvd
Santa Monica, CA 90404-2303

Phone

(310) 829-8618

Fax

(310) 829-8607

NPI assigned

Oct 14, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1639172372
  NPD (past)
• Quincy Physician Corporation

  • Critical Care Medicine (Anesthesiology) Physician
  • Quincy, MA
  • NPI 1144426503
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1811986672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "address_2": "CARDIOVASCULAR DIVISION",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-733-9667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 SANTA MONICA BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042303",
            "telephone_number": "310-829-8618",
            "fax_number": "310-829-8607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Francis St",
            "address_2": "Cardiovascular Division",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021156110",
            "country_code": "US",
            "telephone_number": "617-733-9667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGSTROM",
        "first_name": "LIV",
        "middle_name": "S.",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-14",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10004777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8413650",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lhagstrom982161@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2121 Santa Monica Blvd",
            "city": "Santa Monica",
            "state": "CA",
            "country_code": "US",
            "postal_code": "904042303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ellen Haden, L.M.F.T.
• Hadley Hudson Visions LLC
• Dana Hagooli, PSY.D.
• Michael Hagopian, DO
• Stefan Hagopian, DO
• Romana Haider, M.D.
• Eiftu Solomon Haile
• Stacy Kitter Hajarian, LMFT
• Maryam Hajiabbasi, MD
• Theodore J Hak, MD

• Surgical Physician Assistant in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.