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General NPI Number Information
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NPI Number | 1588715015
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Entity Type | Individual
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Provider Name | STANLEY GORDON POULOS
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 350 BON AIR ROAD SUITE 300
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City | GREENBRAE
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State | CA
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Zip | 94904
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Country | US
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Telephone | 415-925-2880
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Fax | 415-925-2884
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Provider Business Mailing Address
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Address Line | 350 BON AIR ROAD SUITE 300
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City | GREENBRAE
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State | CA
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Zip | 94904
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Country | US
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Telephone | 415-925-2880
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Fax | 415-925-2884
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G31262
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License Number State | CA
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