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General NPI Number Information
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NPI Number | 1699827162
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Entity Type | Individual
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Provider Name | STACY ANN HENIGSMAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 18111 BROOKHURST ST STE 5400
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6728
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Country | US
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Telephone | 714-968-4536
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Fax |
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Provider Business Mailing Address
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Address Line | 10650 REAGAN ST UNIT 1009
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-8854
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Country | US
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Telephone | 714-968-4536
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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 | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 20A8538
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License Number State | CA
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