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General NPI Number Information
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NPI Number | 1912489139
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Entity Type | Individual
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Provider Name | STEPHANIE WEN
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Gender | Female
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 540 RALSTON AVE STE B
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City | BELMONT
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State | CA
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Zip | 94002-2866
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Country | US
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Telephone | 650-363-5668
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Fax | 650-363-5669
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Provider Business Mailing Address
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Address Line | 2450 WALTERS WAY APT 16
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City | CONCORD
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State | CA
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Zip | 94520-3668
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Country | US
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Telephone | 925-448-5327
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA49445
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License Number State | CA
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