Provider Demographics
NPI:1649871492
Name:ZATARAIN, STEPHANIE CRISTINA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CRISTINA
Last Name:ZATARAIN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 E BIRCH ST APT B206
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5101
Mailing Address - Country:US
Mailing Address - Phone:626-201-9189
Mailing Address - Fax:
Practice Address - Street 1:222 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3301
Practice Address - Country:US
Practice Address - Phone:951-278-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant