Basic Information
| Provider Information | |||||||||
| NPI: | 1164795068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DERRINGTON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3142 VISTA WAY STE 206 | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607214000 | ||||||||
| FaxNumber: | 7607214005 | ||||||||
| Practice Location | |||||||||
| Address1: | 3142 VISTA WAY STE 206 | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072555454 | ||||||||
| FaxNumber: | 7072555411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2012 | ||||||||
| LastUpdateDate: | 04/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | UO2698 | FL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 20A14038 | CA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.