Provider Demographics
NPI:1215356688
Name:LACROIX, STEPHANIE DIANE (RNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DIANE
Last Name:LACROIX
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
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Mailing Address - Street 1:3628 E IMPERIAL HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2646
Mailing Address - Country:US
Mailing Address - Phone:310-900-7365
Mailing Address - Fax:310-900-7367
Practice Address - Street 1:808 W 58TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3632
Practice Address - Country:US
Practice Address - Phone:323-541-1600
Practice Address - Fax:310-900-7367
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA377209363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology