Healthcare Provider Details

I. General information

NPI: 1699827162
Provider Name (Legal Business Name): STACY ANN HENIGSMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY ANN BUNN D.O.

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIDEN LN RM 300
NEW YORK NY
10038-4725
US

IV. Provider business mailing address

10650 REAGAN ST UNIT 1009
LOS ALAMITOS CA
90720-8854
US

V. Phone/Fax

Practice location:
  • Phone: 646-290-9560
  • Fax:
Mailing address:
  • Phone: 714-968-4536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number20A8538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: