Provider Demographics
NPI:1740574102
Name:DOUBI, TEPHANIE (MT,CLT,LLCC)
Entity Type:Individual
Prefix:MS
First Name:TEPHANIE
Middle Name:
Last Name:DOUBI
Suffix:
Gender:F
Credentials:MT,CLT,LLCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91341-0064
Mailing Address - Country:US
Mailing Address - Phone:818-554-9668
Mailing Address - Fax:818-890-6692
Practice Address - Street 1:14500 ROSCOE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4190
Practice Address - Country:US
Practice Address - Phone:818-561-6098
Practice Address - Fax:818-890-6692
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKT12101681171M00000X, 174400000X
CA17132225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist