Provider Demographics
NPI:1720298615
Name:SUTHERLAND, STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:SUTHERLAND
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 1:1101 BAYSIDE DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1703
Mailing Address - Country:US
Mailing Address - Phone:949-718-6900
Mailing Address - Fax:949-718-6921
Practice Address - Street 1:1101 BAYSIDE DR
Practice Address - Street 2:STE. 100
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1703
Practice Address - Country:US
Practice Address - Phone:949-718-6900
Practice Address - Fax:949-718-6921
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG657782086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery