Provider Demographics
NPI:1922461151
Name:STEPHENS, DUSTIN B (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:B
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21213 HAWTHORNE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5522
Mailing Address - Country:US
Mailing Address - Phone:424-339-9859
Mailing Address - Fax:
Practice Address - Street 1:21213 HAWTHORNE BLVD STE B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5522
Practice Address - Country:US
Practice Address - Phone:424-339-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1503152084P0800X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry