Provider Demographics
NPI:1295312932
Name:STECCO, KATHRYN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:STECCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5279 APENNINES CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2319
Mailing Address - Country:US
Mailing Address - Phone:408-930-3332
Mailing Address - Fax:
Practice Address - Street 1:5279 APENNINES CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-2319
Practice Address - Country:US
Practice Address - Phone:408-930-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66167208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice