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General NPI Number Information
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NPI Number | 1962089508
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Entity Type | Individual
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Provider Name | STEPHANIE DESLATE NP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 12675 LA MIRADA BLVD STE 220
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City | LA MIRADA
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State | CA
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Zip | 90638-2235
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Country | US
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Telephone | 562-967-2273
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Fax | 562-967-2911
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Provider Business Mailing Address
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Address Line | 12675 LA MIRADA BLVD STE 220
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City | LA MIRADA
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State | CA
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Zip | 90638-2235
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Country | US
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Telephone |
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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 | 95015073
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95114124
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License Number State | CA
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