Provider Demographics
NPI:1215451588
Name:SPEHALSKI, STACEY (PA-C, MPH)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:SPEHALSKI
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40680 WALSH CENTER DR APT 211
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8584
Mailing Address - Country:US
Mailing Address - Phone:484-221-5105
Mailing Address - Fax:
Practice Address - Street 1:31720 TEMECULA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5895
Practice Address - Country:US
Practice Address - Phone:951-303-6900
Practice Address - Fax:951-303-2900
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54687207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology