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NPI Code Detail

MEDICARE: DR. STACY ANN HENIGSMAN D.O.

MEDICARE: DR. STACY ANN HENIGSMAN D.O.
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
1207VX0000XObstetrics Physician20A8538CA

General Provider Information

NPI Number : 1699827162
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY ANN HENIGSMAN D.O.
Provider Business Mailing Address
First Line : 10650 REAGAN ST UNIT 1009
Second Line :
City : LOS ALAMITOS
State : CA
Zip : 90720-8854
Country : US
Telephone Number : 714-968-4536
Fax Number :
Provider Business Practice Location Address
First Line : 90 MAIDEN LN RM 300
Second Line :
City : NEW YORK
State : NY
Zip : 10038-4725
Country : US
Telephone Number : 646-290-9560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 05/21/2026

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