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General NPI Number Information
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NPI Number | 1649737651
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Entity Type | Organization
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Legal Business Name | STANLEY K MATHIS DPM INC
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 211 AVENIDA BARCELONA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-5469
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Country | US
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Telephone | 949-412-8445
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Fax | 949-218-0022
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Provider Business Mailing Address
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Address Line | 211 AVENIDA BARCELONA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-5469
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Country | US
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Telephone | 949-412-8445
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STANLEY KEITH MATHIS
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Credential | DPM
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Telephone | 949-412-8445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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