Stephanie Hsieh
Individual provider Active NPI Physician Assistant · Gualala, CA
NPI 1720868045 · NPPES record last updated Mar 27, 2026
Key facts
- NPI
- 1720868045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 63007 (CA)
- Practice address
- 38001 Old Stage Rd
Gualala, CA 95445-8543 - Phone
- (707) 412-3176
- NPI assigned
- Oct 3, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240916002350 | CA | Practitioner - Physician Assistant | 9537600788 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63007 | CA | MD | Pharmacist |
| PA63007 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mendonoma Health Alliance | Single Specialty | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA63007 | CA | |
| Physician Assistant |
363A00000X | 63007 | CA | Yes |
Addresses
Primary practice location
38001 Old Stage Rd
Gualala, CA 95445-8543
Mailing address
PO Box 1196
Gualala, CA 95445-1196
Other providers in Gualala, CA
- Olaf Kristian Golubjatnikov
- Gualala Pharmacy, Inc.
- Holly Ramona Hamm
- Carolyn Hand
- Douglas Scott Herting
- Mark Kal
- Renee Kaucnik
- Leon Koenck
- Lisa Heying Kritz
- Shaye Larie
All providers in Gualala, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.