Healthcare Provider Details

I. General information

NPI: 1629972781
Provider Name (Legal Business Name): STEPHANIE BARROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 S ALAMEDA ST STE 10
LOS ANGELES CA
90021-1658
US

IV. Provider business mailing address

3556 FLETCHER DR
LOS ANGELES CA
90065-2925
US

V. Phone/Fax

Practice location:
  • Phone: 213-559-1930
  • Fax:
Mailing address:
  • Phone: 213-559-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number791783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: