Provider Demographics
NPI:1255657664
Name:HAMRA, STEPHEN WEERASIT (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WEERASIT
Last Name:HAMRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 TERRACINA BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4851
Mailing Address - Country:US
Mailing Address - Phone:909-307-0964
Mailing Address - Fax:
Practice Address - Street 1:245 TERRACINA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4851
Practice Address - Country:US
Practice Address - Phone:909-307-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics