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General NPI Number Information
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NPI Number | 1386944072
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Entity Type | Organization
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Legal Business Name | STEPHEN M. KRANT M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 528 NAUTILUS ST
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City | LA JOLLA
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State | CA
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Zip | 92037-6138
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Country | US
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Telephone | 858-454-3161
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Fax | 858-454-0790
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Provider Business Mailing Address
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Address Line | 528 NAUTILUS ST
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City | LA JOLLA
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State | CA
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Zip | 92037-6138
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Country | US
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Telephone | 858-454-3161
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Fax | 858-454-0790
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. STEPHEN M KRANT
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Credential | M.D., F.A.C.S.
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Telephone | 858-454-3161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G029780
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License Number State | CA
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