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General NPI Number Information
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NPI Number | 1154555795
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Entity Type | Organization
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Legal Business Name | D STARKS MD INCORPORATED
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 5153 HOLT BLVD SUITE B-2
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City | MONTCLAIR
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State | CA
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Zip | 91763-4837
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Country | US
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Telephone | 909-625-0661
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Fax | 909-625-7761
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Provider Business Mailing Address
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Address Line | 5153 HOLT BLVD SUITE B-2
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City | MONTCLAIR
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State | CA
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Zip | 91763-4837
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Country | US
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Telephone | 909-625-0661
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Fax | 909-625-7761
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Authorized Official
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Title or Position | CEO
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Name | DR. D'MITRI STARKS
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Credential | MD
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Telephone | 909-625-0661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | G49823
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License Number State | CA
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