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: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA18177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: