Healthcare Provider Details

I. General information

NPI: 1558424440
Provider Name (Legal Business Name): STEPHANIE D'AUGUSTINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/03/2023
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 LOMA VISTA RD
VENTURA CA
93003-3099
US

IV. Provider business mailing address

800 S VICTORIA AVE # L4640
VENTURA CA
93009-7672
US

V. Phone/Fax

Practice location:
  • Phone: 805-677-5299
  • Fax:
Mailing address:
  • Phone: 805-677-5146
  • Fax: 805-667-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: