MEDICARE: DR. DEBRA LOUISE STAFFORD M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	G74521	CA

General Provider Information

NPI Number	:	1003994294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA LOUISE STAFFORD M.D

Provider Business Mailing Address
First Line	:	6051 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4401
Country	:	US
Telephone Number	:	323-954-9161
Fax Number	:

Provider Business Practice Location Address
First Line	:	6051 WEST SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036
Country	:	US
Telephone Number	:	323-954-9162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	05/28/2024

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