Healthcare Provider Details

I. General information

NPI: 1639026172
Provider Name (Legal Business Name): STEPHEN LAYTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 IDYLBERRY RD
SAN RAFAEL CA
94903-1131
US

IV. Provider business mailing address

1175 IDYLBERRY RD
SAN RAFAEL CA
94903-1131
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-3730
  • Fax:
Mailing address:
  • Phone: 415-492-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: