Healthcare Provider Details

I. General information

NPI: 1053295907
Provider Name (Legal Business Name): REJOYCE T STEFANIUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 5TH AVE
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

4077 5TH AVE
SAN DIEGO CA
92103-2105
US

V. Phone/Fax

Practice location:
  • Phone: 773-219-4453
  • Fax:
Mailing address:
  • Phone: 773-219-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95035670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: