Healthcare Provider Details

I. General information

NPI: 1508678525
Provider Name (Legal Business Name): STEPHANIE CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9180 LAGUNA MAIN ST SUITE 5
ELK GROVE CA
95758
US

IV. Provider business mailing address

1432 DOAK BLVD
RIPON CA
95366-9399
US

V. Phone/Fax

Practice location:
  • Phone: 916-934-4486
  • Fax: 916-370-9779
Mailing address:
  • Phone: 925-285-2798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF95033259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: