Provider Demographics
NPI:1609308642
Name:RUSH, STEPHANY C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANY
Middle Name:C
Last Name:RUSH
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 1:229 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4003
Mailing Address - Country:US
Mailing Address - Phone:415-503-6000
Mailing Address - Fax:415-503-6096
Practice Address - Street 1:229 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4003
Practice Address - Country:US
Practice Address - Phone:415-503-6000
Practice Address - Fax:415-503-6096
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine