Healthcare Provider Details

I. General information

NPI: 1659628378
Provider Name (Legal Business Name): STEPHEN JOE NEAL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 SOUTH HOOVER STREET
LOS ANGELES CA
90037-4045
US

IV. Provider business mailing address

5701 S HOOVER ST
LOS ANGELES CA
90037-4045
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-6825
  • Fax:
Mailing address:
  • Phone: 562-630-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1104268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: