Provider Demographics
NPI:1972337202
Name:STEPHAN, MEERNA YACOUB (DR)
Entity type:Individual
Prefix:
First Name:MEERNA
Middle Name:YACOUB
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 GUSTAVO ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3289
Mailing Address - Country:US
Mailing Address - Phone:619-456-3192
Mailing Address - Fax:
Practice Address - Street 1:325 KEMPTON ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-5810
Practice Address - Country:US
Practice Address - Phone:619-479-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist