Healthcare Provider Details

I. General information

NPI: 1285019349
Provider Name (Legal Business Name): STEPHANIE LOEW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4193 FLAT ROCK DR SUITE 200-212
RIVERSIDE CA
92505-7111
US

IV. Provider business mailing address

4193 FLAT ROCK DR SUITE 200-212
RIVERSIDE CA
92505-7111
US

V. Phone/Fax

Practice location:
  • Phone: 951-807-0386
  • Fax:
Mailing address:
  • Phone: 951-807-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number173813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: