Provider Demographics
NPI:1629501259
Name:DEPPE, STEPHANIE VILENDRER (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VILENDRER
Last Name:DEPPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:VILENDRER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8550 SANTA MONICA BLVD # 2ND
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4496
Mailing Address - Country:US
Mailing Address - Phone:909-962-1260
Mailing Address - Fax:
Practice Address - Street 1:8550 SANTA MONICA BLVD FL 2
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4496
Practice Address - Country:US
Practice Address - Phone:909-962-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN64421207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine