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General NPI Number Information
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NPI Number | 1174501340
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Entity Type | Individual
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Provider Name | STEPHEN GUGENHEIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 3230 BEARD RD SUITE 2
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City | NAPA
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State | CA
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Zip | 94558-3673
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Country | US
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Telephone | 707-224-7400
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Fax | 707-224-7413
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Provider Business Mailing Address
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Address Line | 3230 BEARD RD SUITE 2
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City | NAPA
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State | CA
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Zip | 94558-3673
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Country | US
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Telephone | 707-224-7400
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Fax | 707-224-7413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | L7739
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | G51162
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License Number State | CA
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