Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G32851 | CA |
NPI | 1023103660 |
---|---|
Provider Name | Stephen B Prepas |
First Address | Newport Beach, CA 92660 |
Second Address | Newport Beach, CA 92660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A45316 | (02) | CA |
GR0044731 | (05) | CA |