Healthcare Provider Details

I. General information

NPI: 1437208394
Provider Name (Legal Business Name): NORA L. STEPHANY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NORA SALLOUM

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 EXECUTIVE DR
SAN DIEGO CA
92121-3018
US

IV. Provider business mailing address

FILE 57326
LOS ANGELES CA
90074-7326
US

V. Phone/Fax

Practice location:
  • Phone: 800-926-8273
  • Fax:
Mailing address:
  • Phone: 800-926-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18177
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA18177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: