Provider Demographics
NPI:1093024994
Name:STYADI, STEPHEN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:STYADI
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E FLORA ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4458
Mailing Address - Country:US
Mailing Address - Phone:909-641-5703
Mailing Address - Fax:760-949-1236
Practice Address - Street 1:1760 E FLORA ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4458
Practice Address - Country:US
Practice Address - Phone:909-641-5703
Practice Address - Fax:760-949-1236
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21209363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical