Healthcare Provider Details

I. General information

NPI: 1477089068
Provider Name (Legal Business Name): GARY WILLIAMS STABLEIN M.D., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 CENTRAL AVE STE 121
CHINO CA
91710-7231
US

IV. Provider business mailing address

3151 AIRWAY AVE STE R
COSTA MESA CA
92626-4627
US

V. Phone/Fax

Practice location:
  • Phone: 949-889-2971
  • Fax:
Mailing address:
  • Phone: 949-889-2971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA171220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: