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General NPI Number Information
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NPI Number | 1154833200
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Entity Type | Organization
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Legal Business Name | DR. STEFIE RIBEIRO O.D, PROF. CORP
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 46660 WASHINGTON ST STE 3
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City | LA QUINTA
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State | CA
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Zip | 92253-2451
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Country | US
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Telephone | 760-564-9944
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Fax |
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Provider Business Mailing Address
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Address Line | 46660 WASHINGTON ST STE 3
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City | LA QUINTA
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State | CA
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Zip | 92253-2451
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Country | US
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Telephone | 760-564-9944
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. STEFIE RIBEIRO
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Credential | OD
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Telephone | 760-564-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14851
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License Number State | CA
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