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General NPI Number Information
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NPI Number | 1679370985
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Entity Type | Individual
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Provider Name | BIANNE STEPHEN U GO NP
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Gender | Male
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 7910 ATLANTIC AVE STE M
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City | CUDAHY
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State | CA
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Zip | 90201-5774
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Country | US
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Telephone | 323-908-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 RAVENNA AVE
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City | WILMINGTON
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State | CA
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Zip | 90744-3120
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Country | US
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Telephone | 310-818-1788
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95034113
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License Number State | CA
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