Provider Demographics
NPI:1366553372
Name:STEVENS, LAURA (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10070 PASADENA AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5942
Mailing Address - Country:US
Mailing Address - Phone:408-746-0300
Mailing Address - Fax:408-343-1285
Practice Address - Street 1:10070 PASADENA AVE STE 2
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5942
Practice Address - Country:US
Practice Address - Phone:408-746-0300
Practice Address - Fax:408-343-1285
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37649207QA0505X, 2081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C376491Medicare PIN