MEDICARE: STEPHEN MCCAIN CNC, CPT, OLY

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	224Y00000X	Clinical Exercise Physiologist	1200502608	CA
2	171400000X	Health & Wellness Coach	1190351195	CA

General Provider Information

NPI Number	:	1770396103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN MCCAIN CNC, CPT, OLY

Provider Business Mailing Address
First Line	:	8744 MESA CANOGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1433
Country	:	US
Telephone Number	:	310-717-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	8744 MESA CANOGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1433
Country	:	US
Telephone Number	:	310-717-8686
Fax Number	:

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

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	01/29/2025

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