Healthcare Provider Details

I. General information

NPI: 1851572986
Provider Name (Legal Business Name): THERESA LYNN STIGEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 E ELDER ST STE K
FALLBROOK CA
92028-3079
US

IV. Provider business mailing address

577 E ELDER ST STE K
FALLBROOK CA
92028-3079
US

V. Phone/Fax

Practice location:
  • Phone: 760-983-4024
  • Fax: 760-723-9010
Mailing address:
  • Phone: 760-983-4024
  • Fax: 760-723-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA108021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: