Healthcare Provider Details

I. General information

NPI: 1548308836
Provider Name (Legal Business Name): STEPHEN JOHN IERARDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24422 AVENIDA DE LA CARLOTA STE 272
LAGUNA HILLS CA
92653-3648
US

IV. Provider business mailing address

24422 AVENIDA DE LA CARLOTA STE 272
LAGUNA HILLS CA
92653-3648
US

V. Phone/Fax

Practice location:
  • Phone: 949-282-6500
  • Fax: 949-282-6501
Mailing address:
  • Phone: 949-282-6500
  • Fax: 949-282-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberG63246
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG63246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: