Healthcare Provider Details

I. General information

NPI: 1952400673
Provider Name (Legal Business Name): STUART B SPENCER SR. HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24310 MOULTON PKWY SUITE D
LAGUNA WOODS CA
92637-3306
US

IV. Provider business mailing address

2510 E SUNSET RD UNIT 5-260
LAS VEGAS NV
89120-3511
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-5330
  • Fax: 949-830-6962
Mailing address:
  • Phone: 702-798-0113
  • Fax: 866-291-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 1354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: