Provider Demographics
NPI:1750371647
Name:STEPHENSON, HECTOR RICARDO (PA)
Entity type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:RICARDO
Last Name:STEPHENSON
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Gender:M
Credentials:PA
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Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:505-925-0100
Practice Address - Street 1:1201 CAMINO DE SALUD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4517
Practice Address - Country:US
Practice Address - Phone:505-925-0286
Practice Address - Fax:505-925-0100
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2024-10-23
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Provider Licenses
StateLicense IDTaxonomies
NMPA2016-0021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant