Provider Demographics
NPI:1659628378
Name:NEAL, STEPHEN JOE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOE
Last Name:NEAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 S HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-4045
Mailing Address - Country:US
Mailing Address - Phone:562-630-6825
Mailing Address - Fax:
Practice Address - Street 1:5701 SOUTH HOOVER STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-4045
Practice Address - Country:US
Practice Address - Phone:562-630-6825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1104268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant