Healthcare Provider Details

I. General information

NPI: 1417890096
Provider Name (Legal Business Name): STEPHEN A LONG NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 OUTLET CENTER DR
OXNARD CA
93036-0677
US

IV. Provider business mailing address

629 N MILL ST
SANTA PAULA CA
93060-1319
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-2400
  • Fax:
Mailing address:
  • Phone: 805-485-2400
  • Fax: 805-485-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95039235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: