Provider Demographics
NPI:1093759110
Name:STEPHANY, HEIDI ANN (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:STEPHANY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ANN
Other - Last Name:PENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:505 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4568
Mailing Address - Country:US
Mailing Address - Phone:714-509-3914
Mailing Address - Fax:888-378-5391
Practice Address - Street 1:505 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4568
Practice Address - Country:US
Practice Address - Phone:714-509-3914
Practice Address - Fax:888-378-5391
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1493202088P0231X
PAMD4485002088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A149320Medicaid