Healthcare Provider Details

I. General information

NPI: 1376830224
Provider Name (Legal Business Name): BETHANY STAFFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 PARKWAY CALABASAS STE 203
CALABASAS CA
91302-3924
US

IV. Provider business mailing address

5000 PARKWAY CALABASAS STE 203
CALABASAS CA
91302-3924
US

V. Phone/Fax

Practice location:
  • Phone: 818-651-9210
  • Fax: 818-584-7934
Mailing address:
  • Phone: 818-651-9210
  • Fax: 818-584-7934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA112150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: