Provider Demographics
NPI:1104957125
Name:RADE, STEPHANIE MARTA (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARTA
Last Name:RADE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14001 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1215
Mailing Address - Country:US
Mailing Address - Phone:310-922-3001
Mailing Address - Fax:
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:STE 403
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-790-7098
Practice Address - Fax:818-790-7099
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI31589Medicare UPIN