Healthcare Provider Details

I. General information

NPI: 1679986277
Provider Name (Legal Business Name): STEPHANIE DOUGLAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PAGE MILL RD STE 200
PALO ALTO CA
94306-2075
US

IV. Provider business mailing address

425 PAGE MILL RD STE 200
PALO ALTO CA
94306-2075
US

V. Phone/Fax

Practice location:
  • Phone: 650-665-9184
  • Fax: 650-710-5985
Mailing address:
  • Phone: 650-665-9184
  • Fax: 650-710-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA198522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: