Healthcare Provider Details

I. General information

NPI: 1184795130
Provider Name (Legal Business Name): TABBY L. STONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BARBOUR ST
PLAYA DEL REY CA
90293-7715
US

IV. Provider business mailing address

215 BARBOUR ST
PLAYA DEL REY CA
90293-7715
US

V. Phone/Fax

Practice location:
  • Phone: 310-306-2427
  • Fax:
Mailing address:
  • Phone: 310-306-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG30110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: