Basic Information
| Provider Information | |||||||||
| NPI: | 1255657664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMRA | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | WEERASIT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 TERRACINA BLVD STE 208 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923734851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093070964 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 245 TERRACINA BLVD STE 208 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923734851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093070964 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2010 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A120543 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.