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General NPI Number Information
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NPI Number | 1609770742
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Entity Type | Individual
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Provider Name | STEPHANIE LYKA VICERAL
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Gender | Female
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 300 BRADFORD ST
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City | REDWOOD CITY
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State | CA
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Zip | 94063-1530
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Country | US
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Telephone | 650-599-1204
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Fax | 650-599-1204
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Provider Business Mailing Address
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Address Line | 17750 RED OAK DR
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City | JAMESTOWN
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State | CA
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Zip | 95327-9219
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Country | US
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Telephone | 209-288-8367
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Fax | 209-288-8367
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95290681
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License Number State | CA
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