Healthcare Provider Details

I. General information

NPI: 1659798718
Provider Name (Legal Business Name): STEPHANIE R VINT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 14TH ST
SANTA MONICA CA
90404-4605
US

IV. Provider business mailing address

1932 14TH ST
SANTA MONICA CA
90404-4605
US

V. Phone/Fax

Practice location:
  • Phone: 310-344-2276
  • Fax: 310-581-9049
Mailing address:
  • Phone: 310-344-2276
  • Fax: 310-581-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: