Provider Demographics
NPI:1376830224
Name:STAFFORD, BETHANY (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:STAFFORD
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 1:7320 WOODLAKE AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4027
Mailing Address - Country:US
Mailing Address - Phone:818-340-3822
Mailing Address - Fax:818-340-8039
Practice Address - Street 1:7320 WOODLAKE AVE STE 270
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-4027
Practice Address - Country:US
Practice Address - Phone:818-340-3822
Practice Address - Fax:818-340-8039
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112150208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics