Healthcare Provider Details

I. General information

NPI: 1992730352
Provider Name (Legal Business Name): JOHN ANTHONY STUNJA RD, LD, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 166 INNER LOOP ROAD WEED ARMY COMMUNITY HOSPITAL
FORT IRWIN CA
92310
US

IV. Provider business mailing address

8705 ANZIO ST # A
FORT IRWIN CA
92310-2405
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-5565
  • Fax:
Mailing address:
  • Phone: 760-386-0835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT05475
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: