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General NPI Number Information
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NPI Number | 1679523914
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Entity Type | Individual
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Provider Name | STEPHANIE N MCCLELLAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 11911 SAN VICENTE BLVD STE 265
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City | LOS ANGELES
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State | CA
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Zip | 90049-6634
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Country | US
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Telephone | 949-463-1990
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Fax |
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Provider Business Mailing Address
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Address Line | 520 MARGUERITE AVE
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2335
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Country | US
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Telephone | 949-463-1990
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | G46111
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License Number State | CA
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