Healthcare Provider Details

I. General information

NPI: 1821527342
Provider Name (Legal Business Name): STEPHANIE FIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W FRANKLIN ST
MONTEREY CA
93940-2725
US

IV. Provider business mailing address

265 FOREST PARK CT
PACIFIC GROVE CA
93950-2409
US

V. Phone/Fax

Practice location:
  • Phone: 831-641-9672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: