Provider Demographics
NPI:1992230312
Name:CU, STEPHANIE CLAIRE V (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE CLAIRE
Middle Name:V
Last Name:CU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E GLENDON WAY
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5529
Mailing Address - Country:US
Mailing Address - Phone:661-454-9324
Mailing Address - Fax:
Practice Address - Street 1:415 E GLENDON WAY
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5529
Practice Address - Country:US
Practice Address - Phone:661-454-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily