MEDICARE: DANIEL PATRICK STEFANKO MD, PHD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A166279	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	390200000X	OTHER	CA	STUDENT HEALTH CARE

General Provider Information

NPI Number	:	1447747050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL PATRICK STEFANKO MD, PHD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-301-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-5004
Country	:	US
Telephone Number	:	310-267-2680
Fax Number	:

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

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	07/26/2022

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