Provider Demographics
NPI:1952734154
Name:STEPHENSON, CHRISTOPHER LEE
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 BUENO DR
Mailing Address - Street 2:UNIT 16
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0758
Mailing Address - Country:US
Mailing Address - Phone:916-715-8176
Mailing Address - Fax:
Practice Address - Street 1:303 VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4340
Practice Address - Country:US
Practice Address - Phone:510-268-3770
Practice Address - Fax:510-268-1073
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program