Provider Demographics
NPI:1356755003
Name:RABOLD, STEFANIE ERIN (NP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ERIN
Last Name:RABOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6208
Mailing Address - Country:US
Mailing Address - Phone:760-681-5222
Mailing Address - Fax:760-681-5151
Practice Address - Street 1:2122 S EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6208
Practice Address - Country:US
Practice Address - Phone:760-681-5222
Practice Address - Fax:760-681-5151
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily