Provider Demographics
NPI:1689905853
Name:STEPHAN, SCOTT A (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:STEPHAN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:26401 CROWN VALLEY PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6302
Mailing Address - Country:US
Mailing Address - Phone:949-586-3200
Mailing Address - Fax:949-900-2136
Practice Address - Street 1:24331 EL TORO RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2752
Practice Address - Country:US
Practice Address - Phone:949-586-3200
Practice Address - Fax:949-900-2136
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2018-09-28
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Provider Licenses
StateLicense IDTaxonomies
CAPA20679363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical