Provider Demographics
NPI:1720297641
Name:STEFAN, ANGELA (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:STEFAN
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 1:2290 MCDANIEL ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6329
Mailing Address - Country:US
Mailing Address - Phone:702-649-1980
Mailing Address - Fax:702-642-2930
Practice Address - Street 1:2290 MCDANIEL ST STE 1B
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6329
Practice Address - Country:US
Practice Address - Phone:702-649-1980
Practice Address - Fax:702-642-2930
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000958Medicaid
NV1720297641Medicaid
NY03094048Medicaid
NV13260OtherNV MEDICAL LICENSE
NVV103994Medicare PIN
NV1720297641Medicaid
WVST6035691Medicare PIN