=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366553372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA STEVENS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 04/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10070 PASADENA AVE STE 2
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-5942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-746-0300
-----------------------------------------------------
Fax | 408-343-1285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10070 PASADENA AVE STE 2
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-5942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-746-0300
-----------------------------------------------------
Fax | 408-343-1285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | C37649
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------