Healthcare Provider Details

I. General information

NPI: 1588003529
Provider Name (Legal Business Name): STANLEY EOSAKUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31569 CANYON ESTATES DR STE 135
LAKE ELSINORE CA
92532-0472
US

IV. Provider business mailing address

31569 CANYON ESTATES DR STE 135
LAKE ELSINORE CA
92532-0472
US

V. Phone/Fax

Practice location:
  • Phone: 951-734-7246
  • Fax: 951-674-7244
Mailing address:
  • Phone: 951-734-7246
  • Fax: 951-674-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA152794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: