MEDICARE: STEPHEN JOHN IERARDI MD

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	G63246	CA
2	207Q00000X	Family Medicine Physician	G63246	CA

General Provider Information

NPI Number	:	1548308836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN JOHN IERARDI MD

Provider Business Mailing Address
First Line	:	24422 AVENIDA DE LA CARLOTA STE 272
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3648
Country	:	US
Telephone Number	:	949-282-6500
Fax Number	:	949-282-6500

Provider Business Practice Location Address
First Line	:	24422 AVENIDA DE LA CARLOTA STE 272
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3648
Country	:	US
Telephone Number	:	949-282-6500
Fax Number	:	949-282-6501

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	12/21/2018

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