Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G74521 | CA |
Y | 208600000X | Surgeon | G74521 | CA |
NPI | 1003994294 |
---|---|
Provider Name | Dr. Debra Louise Stafford |
First Address | Long Beach, CA 90806 |
Second Address | Los Angeles, CA 90036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 11/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G64453 | (02) | CA |