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NPI Code Detail

MEDICARE: DR. STEPHEN MARC WYMAN M.D.

MEDICARE: DR. STEPHEN MARC WYMAN 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
12084P0800XPsychiatry PhysicianA22529CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A22529OTHERCASTATE LICENSE

General Provider Information

NPI Number : 1770760076
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN MARC WYMAN M.D.
Provider Business Mailing Address
First Line : 17011 BEACH BLVD STE 900
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-5998
Country : US
Telephone Number : 714-842-8680
Fax Number :
Provider Business Practice Location Address
First Line : 17011 BEACH BLVD STE 900
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-5998
Country : US
Telephone Number : 714-842-8680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2008
Last Update Date : 03/07/2023

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