Provider Demographics
NPI:1124064209
Name:STEPHEN, ALPHONSA M (MD)
Entity type:Individual
Prefix:DR
First Name:ALPHONSA
Middle Name:M
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5775 S FORT APACHE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5627
Mailing Address - Country:US
Mailing Address - Phone:702-450-0003
Mailing Address - Fax:702-795-3306
Practice Address - Street 1:5775 S FORT APACHE RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5627
Practice Address - Country:US
Practice Address - Phone:702-450-0003
Practice Address - Fax:702-795-3306
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018555Medicaid