MEDICARE: CHRISTINE STEPHENS

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	374T00000X	Religious Nonmedical Nursing Personnel
2	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1225383557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE STEPHENS

Provider Business Mailing Address
First Line	:	812 FREMONT AVE
Second Line	:	202
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-6018
Country	:	US
Telephone Number	:	626-799-7181
Fax Number	:

Provider Business Practice Location Address
First Line	:	4570 GRIFFIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-1422
Country	:	US
Telephone Number	:	323-221-9174
Fax Number	:	323-221-7194

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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Directions to “ CHRISTINE STEPHENS ” Practice Location

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