Healthcare Provider Details

I. General information

NPI: 1831462118
Provider Name (Legal Business Name): STACY ANN FIKERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25262 TERRENO DR
MISSION VIEJO CA
92691-5528
US

IV. Provider business mailing address

25262 TERRENO DR
MISSION VIEJO CA
92691-5528
US

V. Phone/Fax

Practice location:
  • Phone: 310-293-5919
  • Fax:
Mailing address:
  • Phone: 310-293-5919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA126201
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number271454
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: