Healthcare Provider Details

I. General information

NPI: 1245459833
Provider Name (Legal Business Name): STEPHEN PHILIP TOKRAKS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E MAIN ST
EL CAJON CA
92021-5204
US

IV. Provider business mailing address

1630 E MAIN ST
EL CAJON CA
92021-5204
US

V. Phone/Fax

Practice location:
  • Phone: 877-496-0450
  • Fax: 619-590-5155
Mailing address:
  • Phone: 877-497-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A11829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: