Healthcare Provider Details

I. General information

NPI: 1922618537
Provider Name (Legal Business Name): STEPHANIE MEDEL-DE LOERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 E EVENING GLOW AVE
REEDLEY CA
93654-8864
US

IV. Provider business mailing address

2018 E EVENING GLOW AVE
REEDLEY CA
93654-8864
US

V. Phone/Fax

Practice location:
  • Phone: 559-393-9720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: