Healthcare Provider Details

I. General information

NPI: 1265968788
Provider Name (Legal Business Name): CHARI DIANA STUMP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 400
SAN DIEGO CA
92123-2753
US

IV. Provider business mailing address

11280 VISTA SORRENTO PKWY APT 100
SAN DIEGO CA
92130-7638
US

V. Phone/Fax

Practice location:
  • Phone: 858-495-0500
  • Fax:
Mailing address:
  • Phone: 301-908-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA173107
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101269267
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0089953
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: