Healthcare Provider Details

I. General information

NPI: 1073417804
Provider Name (Legal Business Name): AMY STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD STE 300
TEMECULA CA
92591-4678
US

IV. Provider business mailing address

29706 HAZEL GLEN RD
MURRIETA CA
92563-6789
US

V. Phone/Fax

Practice location:
  • Phone: 951-694-0100
  • Fax:
Mailing address:
  • Phone: 619-672-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: