# DERRICK STEPHAN, PA-C INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PAC SURGICAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598234452
- **Authorized official:** DERRICK STEPHAN (OWNER/PROVIDER)
- **Authorized official phone:** (949) 338-3133

## Contact information

- **Practice address:** 33445 PASEO EL LAZO, SAN JUAN CAPISTRANO, CA 92675-1003
- **Practice address phone:** (949) 338-3133
- **Practice address fax:** (949) 266-8586
- **Mailing address:** 33445 PASEO EL LAZO, SAN JUAN CAPISTRANO, CA 92675-1003
- **Mailing address phone:** (949) 338-3133
- **Mailing address fax:** (949) 266-8586

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/20/2018
- **Last updated:** 09/18/2024