Provider Demographics
NPI:1770396103
Name:MCCAIN, STEPHEN (CNC, CPT, OLY)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:CNC, CPT, OLY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8744 MESA CANOGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1433
Mailing Address - Country:US
Mailing Address - Phone:310-717-8686
Mailing Address - Fax:
Practice Address - Street 1:8744 MESA CANOGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1433
Practice Address - Country:US
Practice Address - Phone:310-717-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1200502608224Y00000X
CA1190351195171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist