Provider Demographics
NPI:1700862547
Name:EHRLICH, STEPHEN S (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:EHRLICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27800 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6410
Mailing Address - Country:US
Mailing Address - Phone:949-276-2446
Mailing Address - Fax:949-276-2449
Practice Address - Street 1:27800 MEDICAL CENTER RD
Practice Address - Street 2:SUITE 222
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:949-276-2446
Practice Address - Fax:949-276-2449
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58587207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G585870Medicaid
CAE79864Medicare UPIN
CA00G585870Medicaid