Healthcare Provider Details

I. General information

NPI: 1437899291
Provider Name (Legal Business Name): STEPHANIE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 VISTA HILL AVE
SAN DIEGO CA
92123-2717
US

IV. Provider business mailing address

5694 MISSION CENTER RD STE 602
SAN DIEGO CA
92108-4324
US

V. Phone/Fax

Practice location:
  • Phone: 858-836-8434
  • Fax:
Mailing address:
  • Phone: 619-298-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA190909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: