Provider Demographics
NPI:1184656092
Name:RICCI- FUHRMAN, STEPHANIE T (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:RICCI- FUHRMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-642-5775
Mailing Address - Fax:949-642-2037
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 316
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-642-5775
Practice Address - Fax:949-642-2037
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68435207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA68435AMedicare PIN