Provider Demographics
NPI:1427165703
Name:NUCCION, STEPHEN LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LOUIS
Last Name:NUCCION
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23560 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5233
Mailing Address - Country:US
Mailing Address - Phone:310-784-2355
Mailing Address - Fax:310-517-1817
Practice Address - Street 1:23560 CRENSHAW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5233
Practice Address - Country:US
Practice Address - Phone:310-784-2355
Practice Address - Fax:310-517-1817
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA68856207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02606ZOtherBLUE SHIELD ZZ NUMBER
CAWA68856EMedicare ID - Type Unspecified
CAH68943Medicare UPIN