Provider Demographics
NPI:1821550609
Name:BYRNE, STEPHANIE RAE (MD, MPH, MBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MD, MPH, MBA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:MORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH, MBA
Mailing Address - Street 1:757 WESTWOOD PLAZA
Mailing Address - Street 2:BOX 951752, 3108 RRUMC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8501 WILSHIRE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3135
Practice Address - Country:US
Practice Address - Phone:310-385-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA177273208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program