Healthcare Provider Details

I. General information

NPI: 1144363748
Provider Name (Legal Business Name): STACEY ANNETTE DUNCAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

PO BOX 1135
CULVER CITY CA
90232-1135
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-4526
  • Fax:
Mailing address:
  • Phone: 323-934-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14935
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA14935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: