Provider Demographics
NPI:1386746287
Name:DATU, STEPHEN PACIA (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PACIA
Last Name:DATU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SALE LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2949
Mailing Address - Country:US
Mailing Address - Phone:530-527-8688
Mailing Address - Fax:530-527-8561
Practice Address - Street 1:85 SALE LN
Practice Address - Street 2:SUITE A
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2949
Practice Address - Country:US
Practice Address - Phone:530-527-8688
Practice Address - Fax:530-527-8561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48426207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A484260OtherMEDI CAL
TAX IDOther680304681
CA00A484260Medicare PIN
CA00A484260OtherMEDI CAL