Healthcare Provider Details

I. General information

NPI: 1649652777
Provider Name (Legal Business Name): HEDIEH STEFANACCI, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 E FIR AVE
FRESNO CA
93720-8016
US

IV. Provider business mailing address

2365 E FIR AVE
FRESNO CA
93720-8016
US

V. Phone/Fax

Practice location:
  • Phone: 559-797-9000
  • Fax: 559-797-9005
Mailing address:
  • Phone: 559-797-9000
  • Fax: 559-797-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG81489
License Number StateCA

VIII. Authorized Official

Name: MS. HEDIEH A STEFANACCI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-797-9000