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General NPI Number Information
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NPI Number | 1942699939
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Entity Type | Individual
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Provider Name | STEPHANIE BRIDGMAN SEVILLA NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 393 E WALNUT ST
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City | PASADENA
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State | CA
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Zip | 91188-3390
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Country | US
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Telephone | 951-371-0387
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 HAMNER AVE
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City | NORCO
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State | CA
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Zip | 92860-3117
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Country | US
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Telephone | 951-371-0387
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95001775
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License Number State | CA
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