Provider Demographics
NPI:1598234452
Name:DERRICK STEPHAN, PA-C INC.
Entity Type:Organization
Organization Name:DERRICK STEPHAN, PA-C INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-338-3133
Mailing Address - Street 1:229 RHYTHM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-4254
Mailing Address - Country:US
Mailing Address - Phone:949-338-3133
Mailing Address - Fax:949-266-8586
Practice Address - Street 1:229 RHYTHM
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-4254
Practice Address - Country:US
Practice Address - Phone:949-338-3133
Practice Address - Fax:949-266-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty