Provider Demographics
NPI:1891932950
Name:STEPHAN, DERRICK (PA-C)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:STEPHAN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:33445 PASEO EL LAZO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1003
Mailing Address - Country:US
Mailing Address - Phone:949-338-3133
Mailing Address - Fax:949-338-3133
Practice Address - Street 1:33445 PASEO EL LAZO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1003
Practice Address - Country:US
Practice Address - Phone:949-338-3133
Practice Address - Fax:949-338-3133
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2024-09-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical