Provider Demographics
NPI:1770693178
Name:STEFANACCI, HEDIEH
Entity type:Individual
Prefix:
First Name:HEDIEH
Middle Name:
Last Name:STEFANACCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 E FIR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8016
Mailing Address - Country:US
Mailing Address - Phone:559-797-9000
Mailing Address - Fax:559-797-9005
Practice Address - Street 1:2365 E FIR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8016
Practice Address - Country:US
Practice Address - Phone:559-797-9000
Practice Address - Fax:559-797-9005
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81489208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G814890Medicaid
CAH69586Medicare UPIN
CA00G814890Medicare ID - Type Unspecified