Healthcare Provider Details

I. General information

NPI: 1083845036
Provider Name (Legal Business Name): STEPHANIE N ALDRET D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 HIGHWAY 190 SUITE C
EUNICE LA
70535-5135
US

IV. Provider business mailing address

18444 N 25TH AVE 310
PHOENIX AZ
85023-1261
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-8007
  • Fax: 855-270-5479
Mailing address:
  • Phone: 623-474-3696
  • Fax: 623-544-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number102202830
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4734
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2548
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO.000291
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: