Healthcare Provider Details

I. General information

NPI: 1487306650
Provider Name (Legal Business Name): STEPHANIE ANN HOHMAN DOUGLAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 KATELLA AVE STE 201
LOS ALAMITOS CA
90720-6608
US

IV. Provider business mailing address

4152 KATELLA AVE STE 201
LOS ALAMITOS CA
90720-6608
US

V. Phone/Fax

Practice location:
  • Phone: 562-598-0600
  • Fax: 562-548-0678
Mailing address:
  • Phone: 562-598-0600
  • Fax: 562-548-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: