Provider Demographics
NPI:1275785586
Name:STEFANACCI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STEFANACCI MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEDIEH
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEFENACCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-797-9000
Mailing Address - Street 1:2365 E FIR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8016
Mailing Address - Country:US
Mailing Address - Phone:559-797-9000
Mailing Address - Fax:559-797-9005
Practice Address - Street 1:2365 E FIR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8016
Practice Address - Country:US
Practice Address - Phone:559-797-9000
Practice Address - Fax:559-797-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81489208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G814890Medicare PIN
CAH69586Medicare UPIN