Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | G63246 | CA |
Y | 207Q00000X | Family Doctor | G63246 | CA |
NPI | 1548308836 |
---|---|
Provider Name | Stephen John Ierardi |
First Address | Laguna Hills, CA 92653-3648 |
Second Address | Laguna Hills, CA 92653-3648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 21/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E04679 | (02) | CA |