MEDICARE: STEPHANIE AYROSO MADRIDEJOS FNP-C, FNP-BC

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	363LF0000X	Family Nurse Practitioner	95033918	CA

General Provider Information

NPI Number	:	1548085095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE AYROSO MADRIDEJOS FNP-C, FNP-BC

Provider Business Mailing Address
First Line	:	31 BEACON WAY
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656
Country	:	US
Telephone Number	:	949-413-3811
Fax Number	:	949-317-4670

Provider Business Practice Location Address
First Line	:	8744 CANTALOUPE AVE,
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402
Country	:	US
Telephone Number	:	818-445-4204
Fax Number	:

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

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	02/15/2025

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