Healthcare Provider Details

I. General information

NPI: 1427195676
Provider Name (Legal Business Name): BRETT ERIC STOMPRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4165 BLACKHAWK PLAZA CIR SUITE 150
DANVILLE CA
94506-4904
US

IV. Provider business mailing address

5655 BRUCE DR
PLEASANTON CA
94588-9540
US

V. Phone/Fax

Practice location:
  • Phone: 925-736-0401
  • Fax: 925-736-5609
Mailing address:
  • Phone: 925-248-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG66436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: