Healthcare Provider Details

I. General information

NPI: 1639717473
Provider Name (Legal Business Name): MICHAEL STONE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E 17TH ST STE 101
SANTA ANA CA
92705-6852
US

IV. Provider business mailing address

1950 E 17TH ST STE 101
SANTA ANA CA
92705-6852
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-4300
  • Fax: 714-541-3320
Mailing address:
  • Phone: 714-547-4300
  • Fax: 714-541-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA JANE STONE
Title or Position: PRESIDENT
Credential:
Phone: 714-547-5375