Healthcare Provider Details

I. General information

NPI: 1053463877
Provider Name (Legal Business Name): STEPHEN C. MCNEESE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE SUITE 602
BURBANK CA
91505-4402
US

IV. Provider business mailing address

2701 W ALAMEDA AVE SUITE 602
BURBANK CA
91505-4402
US

V. Phone/Fax

Practice location:
  • Phone: 818-840-8335
  • Fax: 818-843-7384
Mailing address:
  • Phone: 818-840-8335
  • Fax: 818-843-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC037119
License Number StateCA

VIII. Authorized Official

Name: STEPHEN C. MCNEESE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-840-8335