Healthcare Provider Details

I. General information

NPI: 1891090478
Provider Name (Legal Business Name): STEPHANIE ANN STARRITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 OCONNOR DR
SAN JOSE CA
95128-1623
US

IV. Provider business mailing address

333 OCONNOR DR
SAN JOSE CA
95128-1623
US

V. Phone/Fax

Practice location:
  • Phone: 408-297-3484
  • Fax: 408-292-6481
Mailing address:
  • Phone: 408-297-3484
  • Fax: 408-292-6481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: