Healthcare Provider Details

I. General information

NPI: 1710090055
Provider Name (Legal Business Name): DAVID B. STANTON M.D. & ASSOCIATES, A MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE SUITE 555
ORANGE CA
92868-4223
US

IV. Provider business mailing address

1140 W LA VETA AVE SUITE 555
ORANGE CA
92868-4223
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-5100
  • Fax: 714-835-5567
Mailing address:
  • Phone: 714-835-5100
  • Fax: 714-835-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberFNP20614
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID B STANTON
Title or Position: PRESIDENT
Credential: MD
Phone: 714-835-5100