Healthcare Provider Details

I. General information

NPI: 1083579510
Provider Name (Legal Business Name): STEPHANIE KARP CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

878 W 190TH ST
GARDENA CA
90248
US

IV. Provider business mailing address

525 W 104TH ST
LOS ANGELES CA
90044-4401
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-9115
  • Fax:
Mailing address:
  • Phone: 323-394-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: