Healthcare Provider Details

I. General information

NPI: 1124392741
Provider Name (Legal Business Name): STACEY STEVENS SCHMIEDECKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY AEIRN STEVENS

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR DEPT OB/GYN, DIVISION OF MFM
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

34800 BOB WILSON DR DEPT OB/GYN, DIVISION OF MFM
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7020
  • Fax: 619-532-6378
Mailing address:
  • Phone: 619-532-7020
  • Fax: 619-532-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01072991A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number01072991A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: