Provider Demographics
NPI:1669446571
Name:STEPHEN, CHRISTY M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:M
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:11333 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1116
Practice Address - Country:US
Practice Address - Phone:818-869-7269
Practice Address - Fax:818-869-7144
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA63613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13760Medicare ID - Type Unspecified
CAH16517Medicare UPIN