Provider Demographics
NPI:1376771311
Name:STONE, MICHELLE KATHERINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KATHERINE
Last Name:STONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 507
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-642-1361
Mailing Address - Fax:949-642-1608
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 507
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-642-1361
Practice Address - Fax:949-642-1394
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19027363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical