Individual provider Active NPI

Stephanie Pukini

  • Psychiatric/Mental Health Nurse Practitioner
  • Orange, CA
National Provider Identifier
1003509241
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95000480 Issued in CA
Practice address
2592 N Santiago Blvd
Orange, CA 92867-1862
Phone
(855) 434-7763
NPI assigned
Jun 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95000480 CA Primary

Addresses

Primary practice location

2592 N Santiago Blvd
Orange, CA 92867-1862

Mailing address

2592 N Santiago Blvd
Orange, CA 92867-1862
Phone (855) 434-7763

Other names 1

  • Stephanie Marton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230901002057 CA Practitioner - Nurse Practitioner 5991168205

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95000480CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
J M Geiss DO Apc CurrentSince Aug 1, 2023 Accepting new patients
California PHS PC CurrentSince Jan 1, 2024 Accepting new patients

Locations

1420 E Palomar St
Chula Vista, CA 91913

7638 N Ingram Ave
#111A
Fresno, CA 93711

3415 S Sepulveda Blvd
Ste 1100
Los Angeles, CA 90034
Phone (424) 348-4558

1900 Coffee Rd
Modesto, CA 95355
Phone (209) 491-0904

520 Superior Ave
Ste 255
Newport Beach, CA 92663
Phone (949) 720-9266

2592 N Santiago Blvd
Orange, CA 92867
Phone (714) 577-2271

3550 Churn Creek Rd
Redding, CA 96002
Phone (530) 222-3630

5 Hutton Centre Dr
Ste 950
Santa Ana, CA 92707
Phone (855) 434-7663

28650 Newhall Ranch Rd
Santa Clarita, CA 91355
Phone (661) 347-0051

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • FHIR API: https://api.platform.athenahealth.com/19831/brand/2/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1003509241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2592 N SANTIAGO BLVD",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928671862",
            "telephone_number": "855-434-7763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2592 N SANTIAGO BLVD",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928671862",
            "telephone_number": "855-434-7763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUKINI",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-01",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95000480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "MARTON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.