Healthcare Provider Details

I. General information

NPI: 1104452283
Provider Name (Legal Business Name): STEPHEN DERRINGTON, DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 VISTA WAY STE 206
OCEANSIDE CA
92056-3628
US

IV. Provider business mailing address

3142 VISTA WAY STE 206
OCEANSIDE CA
92056-3628
US

V. Phone/Fax

Practice location:
  • Phone: 760-721-4000
  • Fax: 760-721-4005
Mailing address:
  • Phone: 760-721-4000
  • Fax: 760-721-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN DERRINGTON
Title or Position: PHYSICIAN/PRESDIENT
Credential: DO
Phone: 760-721-4000