Healthcare Provider Details

I. General information

NPI: 1396233888
Provider Name (Legal Business Name): VICTORIA JANE STINSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA JANE ROEDER

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 N CAVE CREEK RD
PHOENIX AZ
85032-2976
US

IV. Provider business mailing address

7500 N DREAMY DRAW DR STE 145
PHOENIX AZ
85020-4668
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax: 602-409-0499
Mailing address:
  • Phone: 480-882-4545
  • Fax: 602-409-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: