Healthcare Provider Details

I. General information

NPI: 1790003325
Provider Name (Legal Business Name): STEPHANIE MARIE WHITTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATHAM BLVD
OXNARD CA
93033
US

IV. Provider business mailing address

1180 NEWFIELD AVE
STAMFORD CT
06905-1409
US

V. Phone/Fax

Practice location:
  • Phone: 805-330-8680
  • Fax:
Mailing address:
  • Phone: 314-888-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA116253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: