Individual
STACEY MCILROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
22 CORPORATE PLAZA DR, NEWPORT BEACH, CA 92660-7985
(949) 722-7038
(949) 630-4900
Mailing address
22 CORPORATE PLAZA DR., NEWPORT BEACH, CA 92660
(949) 722-5017
(949) 432-3354
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
2272
AZ
363AS0400X
Surgical Physician Assistant
Primary
53563
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
486549
—
AZ
01
—
86080015085259C297
TRIWEST
AZ
01
—
P00021617
RAILROAD MEDICARE
AZ
Enumeration date
12/20/2005
Last updated
03/17/2018
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