Healthcare Provider Details

I. General information

NPI: 1699723932
Provider Name (Legal Business Name): EDWARD ALAN STADLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY SUITE 525
MISSION VIEJO CA
92691-8029
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY SUITE 525
MISSION VIEJO CA
92691-8029
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1040
  • Fax: 949-365-7037
Mailing address:
  • Phone: 949-364-1040
  • Fax: 949-365-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG23122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: