Healthcare Provider Details

I. General information

NPI: 1710718176
Provider Name (Legal Business Name): STEPHEN PAUL KARLSTROMER IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34101 FARENHOLT AVE BLDG 14
SAN DIEGO CA
92134-7000
US

IV. Provider business mailing address

12481 HEATHERTON CT APT 22
SAN DIEGO CA
92128-5136
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7968
  • Fax:
Mailing address:
  • Phone: 540-656-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: