Provider Demographics
NPI:1740570985
Name:STRAND, STEPHEN R (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:STRAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12683 AVENUE 416
Mailing Address - Street 2:
Mailing Address - City:OROSI
Mailing Address - State:CA
Mailing Address - Zip Code:93647-2017
Mailing Address - Country:US
Mailing Address - Phone:559-528-4717
Mailing Address - Fax:559-528-0302
Practice Address - Street 1:12683 AVENUE 416
Practice Address - Street 2:
Practice Address - City:OROSI
Practice Address - State:CA
Practice Address - Zip Code:93647-2017
Practice Address - Country:US
Practice Address - Phone:559-528-4717
Practice Address - Fax:559-528-0302
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21513363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant