Provider Demographics
NPI:1699827162
Name:HENIGSMAN, STACY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ANN
Last Name:HENIGSMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:BUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:10650 REAGAN ST UNIT 1009
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-8854
Mailing Address - Country:US
Mailing Address - Phone:714-968-4536
Mailing Address - Fax:
Practice Address - Street 1:18111 BROOKHURST ST STE 5400
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-968-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8538207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics