Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 468795 | CA |
NPI | 1073850566 |
---|---|
Provider Name | Lilia Isabel Stephenson |
First Address | San Pedro, CA 90732-4613 |
Second Address | San Pedro, CA 90732-4613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2013 |
Last Update Date | 03/01/2013 |