Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | DC25387 | CA |
N | 111NX0100X | Occupational Health | DC25387 | CA |
NPI | 1801993191 |
---|---|
Provider Name | Dr. Joseph Michael Stephano |
First Address | Vallejo, CA 94590-2943 |
Second Address | Vallejo, CA 94590-2943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U78666 | (02) | CA |