Healthcare Provider Details

I. General information

NPI: 1639651367
Provider Name (Legal Business Name): KEVIN STEPHENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MASON ST
VACAVILLE CA
95688-4646
US

IV. Provider business mailing address

910 CAMPISI WAY STE 1A
CAMPBELL CA
95008-2350
US

V. Phone/Fax

Practice location:
  • Phone: 866-375-2437
  • Fax:
Mailing address:
  • Phone: 866-375-2437
  • Fax: 408-273-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: