MEDICARE: BETHANY STAFFORD M.D.

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
1	208000000X	Pediatrics Physician	A112150	CA

General Provider Information

NPI Number	:	1376830224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY STAFFORD M.D.

Provider Business Mailing Address
First Line	:	7320 WOODLAKE AVE STE 270
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4027
Country	:	US
Telephone Number	:	818-340-3822
Fax Number	:	818-340-8039

Provider Business Practice Location Address
First Line	:	7320 WOODLAKE AVE STE 270
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4027
Country	:	US
Telephone Number	:	818-340-3822
Fax Number	:	818-340-8039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/12/2023

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