Healthcare Provider Details

I. General information

NPI: 1093759110
Provider Name (Legal Business Name): HEIDI ANN STEPHANY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI ANN PENN M.D.

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 100
ORANGE CA
92868-4568
US

IV. Provider business mailing address

505 S MAIN ST STE 100
ORANGE CA
92868-4568
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-3914
  • Fax: 888-378-5391
Mailing address:
  • Phone: 714-509-3914
  • Fax: 888-378-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberA149320
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD448500
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: