Healthcare Provider Details

I. General information

NPI: 1689905853
Provider Name (Legal Business Name): SCOTT A STEPHAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24331 EL TORO RD SUITE 200
LAGUNA WOODS CA
92637-2752
US

IV. Provider business mailing address

26401 CROWN VALLEY PKWY STE 101
MISSION VIEJO CA
92691-6302
US

V. Phone/Fax

Practice location:
  • Phone: 949-586-3200
  • Fax: 949-900-2136
Mailing address:
  • Phone: 949-586-3200
  • Fax: 949-900-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA20679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: