Provider Demographics
NPI:1275553497
Name:MIKULICS, STEFANIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:ANN
Last Name:MIKULICS
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 1:1050 LAS TABLAS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9729
Mailing Address - Country:US
Mailing Address - Phone:805-434-9441
Mailing Address - Fax:805-434-9456
Practice Address - Street 1:1050 LAS TABLAS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9729
Practice Address - Country:US
Practice Address - Phone:805-434-9441
Practice Address - Fax:805-434-9456
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68329207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A683290OtherBLUE SHIELD PIN
CA00A683290Medicaid
CAGR0092204Medicaid
CA00A683290Medicaid
CAW15907Medicare PIN