Basic Information
Provider Information
NPI: 1417115544
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUSH
FirstName: STEPHANIE
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 EMBARCADERO CTR STE 1900
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941113723
CountryCode: US
TelephoneNumber: 4156586791
FaxNumber: 4155200904
Practice Location
Address1: 1827 ADAMS MILL RD NW STE C
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200092399
CountryCode: US
TelephoneNumber: 2026271903
FaxNumber: 2026600025
Other Information
ProviderEnumerationDate: 05/27/2008
LastUpdateDate: 03/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XDO034894DCY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XN3281TXN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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