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Organization
STEPHEN B. PREPAS, M.D., A MEDICAL CORPORATION
Active
Organization
STEPHEN B. PREPAS, M.D., A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN B. PREPAS M.D. (PHYSICIAN)
(949) 644-7026
Entity
Organization
Contact information
Practice address
360 SAN MIGUEL DR, SUITE 407, NEWPORT BEACH, CA 92660-7822
(949) 644-7026
(949) 644-7029
Mailing address
360 SAN MIGUEL DRIVE, SUITE 407, NEWPORT BEACH, CA 92660-7822
(949) 644-7026
(949) 644-7029
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G32851
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G328510
BLUE CROSS ID
CA
01
—
1023103660
INDIVIDUAL PROVIDER NPI
CA
01
—
G32851
LICENSE
CA
01
—
GR0044731
MEDI-CAL
CA
Enumeration date
05/09/2007
Last updated
08/22/2020
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