Healthcare Provider Details

I. General information

NPI: 1194771956
Provider Name (Legal Business Name): STEPHEN F SIGNER MD CM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11770 BERNARDO PLAZA COURT SUITE 370
SAN DIEGO CA
92128-2426
US

IV. Provider business mailing address

PO BOX 609001
SAN DIEGO CA
92160-9001
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-3360
  • Fax: 858-592-0884
Mailing address:
  • Phone: 619-528-4600
  • Fax: 619-528-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberG51749
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG51749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: