Provider Demographics
NPI:1790710655
Name:HANSON, STEPHEN H (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:HANSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9530 HAGEMAN RD B-204
Mailing Address - Street 2:CALIFORNIA PA STAFFING INC
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3959
Mailing Address - Country:US
Mailing Address - Phone:661-742-7121
Mailing Address - Fax:661-589-2326
Practice Address - Street 1:9530 HAGEMAN RD B-204
Practice Address - Street 2:CALIFORNIA PA STAFFING INC
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-3959
Practice Address - Country:US
Practice Address - Phone:661-742-7121
Practice Address - Fax:661-589-2326
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 11069363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABQ547ZMedicare UPIN
CA0PA110690Medicare ID - Type Unspecified