Basic Information
| Provider Information | |||||||||
| NPI: | 1043448236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 2ND ST | ||||||||
| Address2: | SUITE 415 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941071469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155294567 | ||||||||
| FaxNumber: | 4152910489 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 2ND ST | ||||||||
| Address2: | SUITE 415 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941071469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155294567 | ||||||||
| FaxNumber: | 4152910489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MR-1054 | ID | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | M-11169 | ID | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | A128190 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.