Provider Demographics
NPI:1225242688
Name:STEPHEN B. PREPAS, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STEPHEN B. PREPAS, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PREPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-7026
Mailing Address - Street 1:360 SAN MIGUEL DRIVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7822
Mailing Address - Country:US
Mailing Address - Phone:949-644-7026
Mailing Address - Fax:949-644-7029
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 407
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7822
Practice Address - Country:US
Practice Address - Phone:949-644-7026
Practice Address - Fax:949-644-7029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0044731OtherMEDI-CAL
CAG32851OtherLICENSE
CA00G328510OtherBLUE CROSS ID
CA1023103660OtherINDIVIDUAL PROVIDER NPI
CAG32851OtherLICENSE
CAGR0044731OtherMEDI-CAL
CAA45316Medicare UPIN