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General NPI Number Information
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NPI Number | 1891932950
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Entity Type | Individual
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Provider Name | DERRICK STEPHAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 33445 PASEO EL LAZO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1003
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Country | US
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Telephone | 949-338-3133
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Fax | 949-338-3133
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Provider Business Mailing Address
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Address Line | 33445 PASEO EL LAZO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1003
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Country | US
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Telephone | 949-338-3133
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Fax | 949-338-3133
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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