Healthcare Provider Details

I. General information

NPI: 1215451588
Provider Name (Legal Business Name): STACEY SPEHALSKI PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31720 TEMECULA PKWY STE 200
TEMECULA CA
92592-5895
US

IV. Provider business mailing address

40680 WALSH CENTER DR APT 211
MURRIETA CA
92562-8584
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-6900
  • Fax: 951-303-2900
Mailing address:
  • Phone: 484-221-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number54687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: