Healthcare Provider Details

I. General information

NPI: 1497311278
Provider Name (Legal Business Name): STELLA KIRAKOSIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 W SYCAMORE AVE
ORANGE CA
92868-1936
US

IV. Provider business mailing address

2214 W SYCAMORE AVE
ORANGE CA
92868-1936
US

V. Phone/Fax

Practice location:
  • Phone: 714-719-1240
  • Fax:
Mailing address:
  • Phone: 714-719-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: