Healthcare Provider Details

I. General information

NPI: 1750467346
Provider Name (Legal Business Name): JOAN STOYKOVICH PA-C, RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E CHAPMAN AVE SUITE 4
ORANGE CA
92866-2237
US

IV. Provider business mailing address

8722 ROOSEVELT CIR
BUENA PARK CA
90620-3848
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-4600
  • Fax: 714-633-1412
Mailing address:
  • Phone: 714-826-9436
  • Fax: 714-826-9436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA11624
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA11624
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number282419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: