Healthcare Provider Details

I. General information

NPI: 1942243456
Provider Name (Legal Business Name): JOHN STIRLING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 GRANADA AVE
SAN DIEGO CA
92102-1435
US

IV. Provider business mailing address

1629 GRANADA AVE
SAN DIEGO CA
92102-1435
US

V. Phone/Fax

Practice location:
  • Phone: 360-281-5684
  • Fax:
Mailing address:
  • Phone: 360-281-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberG88086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: