Provider Demographics
NPI:1427892884
Name:BACCARI, STEPHEN ALEXANDER (NP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ALEXANDER
Last Name:BACCARI
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Gender:
Credentials:NP
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Mailing Address - Street 1:436 N BEDFORD DR STE 306
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4320
Mailing Address - Country:US
Mailing Address - Phone:310-274-4401
Mailing Address - Fax:310-499-5923
Practice Address - Street 1:11645 WILSHIRE BLVD STE 900
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6811
Practice Address - Country:US
Practice Address - Phone:310-274-4401
Practice Address - Fax:213-408-4414
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA77432207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology