Healthcare Provider Details

I. General information

NPI: 1225711286
Provider Name (Legal Business Name): MARLISE STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S MAIN ST
SALINAS CA
93901-2260
US

IV. Provider business mailing address

30 STEPHENS DR
SAN JUAN BAUTISTA CA
95045-9409
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-7777
  • Fax:
Mailing address:
  • Phone: 831-801-1699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: