Healthcare Provider Details

I. General information

NPI: 1922089234
Provider Name (Legal Business Name): STACEY G JAMES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24902 MOULTON PKWY SUITE 200
LAGUNA HILLS CA
92637-6410
US

IV. Provider business mailing address

PO BOX 2549
MISSION VIEJO CA
92690-0549
US

V. Phone/Fax

Practice location:
  • Phone: 949-462-0560
  • Fax:
Mailing address:
  • Phone: 949-462-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: