Provider Demographics
NPI:1194917575
Name:STEPHENS, SAHAR M (MD)
Entity type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAHAR
Other - Middle Name:L
Other - Last Name:MASOUDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1130 CONROY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4156
Mailing Address - Country:US
Mailing Address - Phone:916-773-2229
Mailing Address - Fax:
Practice Address - Street 1:1130 CONROY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4156
Practice Address - Country:US
Practice Address - Phone:916-773-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129992207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75735547Medicaid
COCOA106522Medicare PIN