Healthcare Provider Details

I. General information

NPI: 1437242252
Provider Name (Legal Business Name): CHARLES JACOB STOLAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 CASTILLO ST SUITE 202
SANTA BARBARA CA
93105-5316
US

IV. Provider business mailing address

2403 CASTILLO ST SUITE 202
SANTA BARBARA CA
93105-5316
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-6560
  • Fax: 805-563-3680
Mailing address:
  • Phone: 805-563-6560
  • Fax: 805-563-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number150347
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberG89130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: