Provider Demographics
NPI:1629836192
Name:ADANALIAN, STEPHANIE RENEE (ELECTROLOGIST)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:ADANALIAN
Suffix:
Gender:F
Credentials:ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-1708
Mailing Address - Country:US
Mailing Address - Phone:559-392-0982
Mailing Address - Fax:
Practice Address - Street 1:536 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3250
Practice Address - Country:US
Practice Address - Phone:559-392-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-9875171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty