Provider Demographics
NPI:1134502784
Name:GENENDER, STEPHEN EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EARL
Last Name:GENENDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 WRIGHTWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:323-654-2226
Mailing Address - Fax:323-654-9895
Practice Address - Street 1:3293 WRIGHTWOOD DR.
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604
Practice Address - Country:US
Practice Address - Phone:323-654-2226
Practice Address - Fax:323-654-9895
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20412208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery