Provider Demographics
NPI:1548410343
Name:OLDHAM, STEPHAN E
Entity Type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:E
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 SPRINGWOOD ST
Mailing Address - Street 2:APT B
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2780
Mailing Address - Country:US
Mailing Address - Phone:951-532-9787
Mailing Address - Fax:
Practice Address - Street 1:790 SPRINGWOOD ST
Practice Address - Street 2:APT B
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2780
Practice Address - Country:US
Practice Address - Phone:951-532-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health