Healthcare Provider Details

I. General information

NPI: 1275784233
Provider Name (Legal Business Name): STEPHEN WAYNE HARGETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTH STATE ST.
LOS ANGELES CA
90033
US

IV. Provider business mailing address

530 SO. HEWITT ST. 330
LOS ANGELES CA
90013
US

V. Phone/Fax

Practice location:
  • Phone: 805-231-1321
  • Fax:
Mailing address:
  • Phone: 805-231-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA033434
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA033434
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA33434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: