Healthcare Provider Details

I. General information

NPI: 1780046631
Provider Name (Legal Business Name): STEPHANIE DIANA WARRINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD STE A100
GLENDALE AZ
85306-4661
US

IV. Provider business mailing address

4530 E SHEA BLVD STE 180
PHOENIX AZ
85028-6042
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3205
  • Fax: 602-938-5799
Mailing address:
  • Phone: 602-264-4834
  • Fax: 602-257-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number66160
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number66160
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101271992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: