Healthcare Provider Details

I. General information

NPI: 1669217907
Provider Name (Legal Business Name): STEPHEN ARREY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 10/19/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12640 HESPERIA RD STE D
VICTORVILLE CA
92395-7753
US

IV. Provider business mailing address

8990 GARFIED ST 6
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 760-684-8999
  • Fax:
Mailing address:
  • Phone: 951-343-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: