Individual
MS. STEPHANIE FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4647 ZION AVE, SAN DIEGO, CA 92120-2507
(619) 528-7266
(619) 528-6161
Mailing address
4647 ZION AVE, SAN DIEGO, CA 92120-2507
(619) 528-7266
(519) 528-6161
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
143564
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600420015
—
MO
Enumeration date
11/04/2008
Last updated
12/13/2021
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