Healthcare Provider Details

I. General information

NPI: 1497194328
Provider Name (Legal Business Name): STEPHANIE LYNN STEFANELLI PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE LYNN GOMEZ PSY. D

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 YOUTH WAY BLDG 1
FULLERTON CA
92835-3819
US

IV. Provider business mailing address

4851 TORIDA WAY
YORBA LINDA CA
92886-3635
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9264
  • Fax:
Mailing address:
  • Phone: 951-252-4978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY27869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: