Healthcare Provider Details

I. General information

NPI: 1023235686
Provider Name (Legal Business Name): STEPHEN SEWALL CHAPIN MBA, CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 VISTA HILL AVE
SAN DIEGO CA
92123-2717
US

IV. Provider business mailing address

3658 OLD COBBLE RD
SAN DIEGO CA
92111-4048
US

V. Phone/Fax

Practice location:
  • Phone: 858-573-8984
  • Fax:
Mailing address:
  • Phone: 858-573-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: