Healthcare Provider Details

I. General information

NPI: 1689132714
Provider Name (Legal Business Name): STEPHEN HERRINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 41ST AVE
CAPITOLA CA
95010-2056
US

IV. Provider business mailing address

390 UNION BLVD STE 300
LAKEWOOD CO
80228-6514
US

V. Phone/Fax

Practice location:
  • Phone: 707-933-7252
  • Fax:
Mailing address:
  • Phone: 707-933-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: