Individual
STEPHANIE WYCKOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18035 BROOKHURST STREET, SUITE 2100, FOUNTAIN VALLEY, CA 92708
(657) 241-9090
Mailing address
17360 BROOKHURST ST, ATTN: CREDENTIALING DEPARTMENT, FOUNTAIN VALLEY, CA 92708-3720
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
A69149
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A691490
—
CA
Enumeration date
10/27/2006
Last updated
10/14/2016
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