Provider Demographics
NPI:1619949856
Name:STEJSKAL, MICHAEL FRANCIS (MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:STEJSKAL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27349 JEFFERSON AVE
Mailing Address - Street 2:#112
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5634
Mailing Address - Country:US
Mailing Address - Phone:951-296-5690
Mailing Address - Fax:951-296-5693
Practice Address - Street 1:27349 JEFFERSON AVE
Practice Address - Street 2:#112
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5634
Practice Address - Country:US
Practice Address - Phone:951-296-5690
Practice Address - Fax:951-296-5693
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU968231H00000X
CAHA2188231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4594692OtherAETNA ID#
CAZZZ25969ZMedicare ID - Type UnspecifiedMEDICARE GRP
CAZZZ25970ZMedicare ID - Type UnspecifiedMEMBER ID