Basic Information
| Provider Information | |||||||||
| NPI: | 1619095940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEPHENSON | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | SHEVETTE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3568 S BUDLONG AVE | ||||||||
| Address2: | APT. #3 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900073417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234025275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5201 S VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900373527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237512677 | ||||||||
| FaxNumber: | 3237510971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.