Healthcare Provider Details

I. General information

NPI: 1396447017
Provider Name (Legal Business Name): MICHAEL LOUIS STEPHENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8975 BALBOA AVE
SAN DIEGO CA
92123-1507
US

IV. Provider business mailing address

8975 BALBOA AVE FL 2
SAN DIEGO CA
92123-1507
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2710
  • Fax: 858-262-8668
Mailing address:
  • Phone: 858-499-2710
  • Fax: 858-262-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA207926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: