Healthcare Provider Details

I. General information

NPI: 1780111583
Provider Name (Legal Business Name): STEPHANIE CAROL-OZIEGBE JOSEPH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C230
LA JOLLA CA
92037-1712
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR STE C230
LA JOLLA CA
92037-1712
US

V. Phone/Fax

Practice location:
  • Phone: 206-906-5385
  • Fax:
Mailing address:
  • Phone: 206-906-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA196517
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT0821
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberT0821
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA196517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: