Healthcare Provider Details

I. General information

NPI: 1003932187
Provider Name (Legal Business Name): SERGIO STONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E 2ND ST
CALEXICO CA
92231-2847
US

IV. Provider business mailing address

408 E 2ND ST
CALEXICO CA
92231-2847
US

V. Phone/Fax

Practice location:
  • Phone: 714-282-1492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA32484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: