Provider Demographics
NPI:1710040605
Name:DADA, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:DADA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:36320 INLAND VALLEY DR.
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7512
Mailing Address - Country:US
Mailing Address - Phone:951-698-3000
Mailing Address - Fax:951-698-7700
Practice Address - Street 1:36320 INLAND VALLEY DR.
Practice Address - Street 2:SUITE 101A
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7512
Practice Address - Country:US
Practice Address - Phone:951-698-3000
Practice Address - Fax:951-698-7700
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2023-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA86832208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710040605Medicaid
CAET544AOtherMEDICARE PTAN