Healthcare Provider Details

I. General information

NPI: 1710175203
Provider Name (Legal Business Name): STEPHENSON, ACQUISTO AND COLMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N GLENOAKS BLVD STE 700
BURBANK CA
91502-3226
US

IV. Provider business mailing address

303 N GLENOAKS BLVD STE 700
BURBANK CA
91502-3226
US

V. Phone/Fax

Practice location:
  • Phone: 818-559-4477
  • Fax: 818-559-5484
Mailing address:
  • Phone: 818-559-4477
  • Fax: 818-559-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberATTORNEY 113755
License Number StateCA

VIII. Authorized Official

Name: MS. SHERRI BUDRY
Title or Position: HR DIRECTOR
Credential:
Phone: 818-559-4477