Provider Demographics
NPI:1306300272
Name:GONDA, STEPHANIE O'BRIEN (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:O'BRIEN
Last Name:GONDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:O'BRIEN
Other - Last Name:SRAMEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13546 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1730
Mailing Address - Country:US
Mailing Address - Phone:858-444-5828
Mailing Address - Fax:
Practice Address - Street 1:3830 VALLEY CENTRE DR STE 702
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3307
Practice Address - Country:US
Practice Address - Phone:858-720-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010771363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner