Healthcare Provider Details

I. General information

NPI: 1285197384
Provider Name (Legal Business Name): STEPANIDA FREEMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREENWAY PKWY STE 3B
HENDERSON NV
89704
US

IV. Provider business mailing address

220 STANDIFORD AVE STE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 702-737-3200
  • Fax:
Mailing address:
  • Phone: 209-579-5628
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPANIDA FREEMAN
Title or Position: OWNER
Credential: MD
Phone: 480-652-7776