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Individual

DR. STEPHANUS R PHILIP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3291 LOMA VISTA RD, VENTURA, CA 93003-3099
(805) 652-6075
(805) 652-6286
Mailing address
3291 LOMA VISTA RD, VENTURA, CA 93003-3099
(805) 652-6075
(805) 652-6286

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A87363
CA
208000000X
Pediatrics Physician
A87363
CA
208M00000X
Hospitalist Physician
Primary
A87363
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A873630
MCAL PROVIDER NUMBER
CA
01
WA87363D
MEDICARE PTAN
CA
Enumeration date
06/17/2006
Last updated
07/17/2023
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