Healthcare Provider Details

I. General information

NPI: 1912943994
Provider Name (Legal Business Name): STEPHANIE MCCLELLAN, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE STE 205
NEWPORT BEACH CA
92660-7703
US

IV. Provider business mailing address

1441 AVOCADO AVE STE 205
NEWPORT BEACH CA
92660-7703
US

V. Phone/Fax

Practice location:
  • Phone: 949-719-3600
  • Fax: 949-644-7344
Mailing address:
  • Phone: 949-719-3600
  • Fax: 949-644-7344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE N MCCLELLAN
Title or Position: FOUNDER
Credential: M.D.
Phone: 949-719-3600