Healthcare Provider Details

I. General information

NPI: 1598209702
Provider Name (Legal Business Name): PAIGE STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 CAMPUS ST STE A1117
LOMA LINDA CA
92350-1700
US

IV. Provider business mailing address

11175 CAMPUS ST STE A1117
LOMA LINDA CA
92350-1700
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4250
  • Fax:
Mailing address:
  • Phone: 909-558-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA153453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: