Healthcare Provider Details

I. General information

NPI: 1700847704
Provider Name (Legal Business Name): PATRICIA N STEPHENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17742 BEACH BLVD SUITE 360
HUNTINGTON BEACH CA
92647-6818
US

IV. Provider business mailing address

17742 BEACH BLVD SUITE 360
HUNTINGTON BEACH CA
92647-6818
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-0868
  • Fax: 714-848-2248
Mailing address:
  • Phone: 714-848-0868
  • Fax: 714-848-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC41275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: