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NPI Code Detail

MEDICARE: STEPHEN LONG RN

MEDICARE:   STEPHEN  LONG  RN
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
1363LA2100XAcute Care Nurse Practitioner95039235CA

General Provider Information

NPI Number : 1417890096
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN LONG RN
Provider Business Mailing Address
First Line : 629 N MILL ST
Second Line :
City : SANTA PAULA
State : CA
Zip : 93060-1319
Country : US
Telephone Number : 805-485-2400
Fax Number :
Provider Business Practice Location Address
First Line : 1910 OUTLET CENTER DR
Second Line :
City : OXNARD
State : CA
Zip : 93036-0677
Country : US
Telephone Number : 805-485-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2026
Last Update Date : 04/10/2026

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