Provider Demographics
NPI:1558903096
Name:DEPAOLA, STEPHANIE DEPAOLA A (LAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE DEPAOLA
Middle Name:A
Last Name:DEPAOLA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 HAYES ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1365
Mailing Address - Country:US
Mailing Address - Phone:503-290-4877
Mailing Address - Fax:
Practice Address - Street 1:2137 LOMBARD ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2773
Practice Address - Country:US
Practice Address - Phone:415-673-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16250171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist