Healthcare Provider Details

I. General information

NPI: 1649871492
Provider Name (Legal Business Name): STEPHANIE CRISTINA ZATARAIN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 6TH ST
CORONA CA
92882-3301
US

IV. Provider business mailing address

1717 E BIRCH ST APT B206
BREA CA
92821-5101
US

V. Phone/Fax

Practice location:
  • Phone: 951-278-2530
  • Fax:
Mailing address:
  • Phone: 626-201-9189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: