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NPI Code Detail

MEDICARE: STEPHEN B. PREPAS, M.D., A MEDICAL CORPORATION

MEDICARE: STEPHEN B. PREPAS, M.D., A MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistG32851CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GR0044731OTHERCAMEDI-CAL
2G32851OTHERCALICENSE
300G328510OTHERCABLUE CROSS ID
41023103660OTHERCAINDIVIDUAL PROVIDER NPI

General Provider Information

NPI Number : 1225242688
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEPHEN B. PREPAS, M.D., A MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 360 SAN MIGUEL DRIVE
Second Line : SUITE 407
City : NEWPORT BEACH
State : CA
Zip : 92660-7822
Country : US
Telephone Number : 949-644-7026
Fax Number : 949-644-7029
Provider Business Practice Location Address
First Line : 360 SAN MIGUEL DR
Second Line : SUITE 407
City : NEWPORT BEACH
State : CA
Zip : 92660-7822
Country : US
Telephone Number : 949-644-7026
Fax Number : 949-644-7029
Authorized Official
Title or Position : PHYSICIAN
Name : DR. STEPHEN B. PREPAS
Credential : M.D.
Telephone Number : 949-644-7026
Provider Enumeration Date : 05/09/2007
Last Update Date : 08/22/2020

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