Healthcare Provider Details

I. General information

NPI: 1528294576
Provider Name (Legal Business Name): IRVINE E STEWART MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 4TH AVE SUITE 300
SAN DIEGO CA
92103-3119
US

IV. Provider business mailing address

930 BISHOPS GATE LN APT A
KIRKWOOD MO
63122-6468
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-2441
  • Fax:
Mailing address:
  • Phone: 314-206-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: