Provider Demographics
NPI:1629220025
Name:LONDE, STEPHEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:LONDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:P
Other - Last Name:LONDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2855 ROSCOMARE RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1626
Mailing Address - Country:US
Mailing Address - Phone:310-476-0656
Mailing Address - Fax:310-476-7906
Practice Address - Street 1:2855 ROSCOMARE RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1626
Practice Address - Country:US
Practice Address - Phone:310-476-0656
Practice Address - Fax:310-476-7906
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE35440208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACFE35440OtherCALIFORNIA MEDICAL LICENSE