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General NPI Number Information
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NPI Number | 1851521231
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Entity Type | Organization
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Legal Business Name | MYSTICAL ROSE OBSTETRICS AND GYNECOLOGY
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 577 E ELDER ST STE K
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City | FALLBROOK
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State | CA
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Zip | 92028-3079
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Country | US
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Telephone | 760-983-4024
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Fax | 760-723-9010
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Provider Business Mailing Address
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Address Line | 577 E ELDER ST STE K
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City | FALLBROOK
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State | CA
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Zip | 92028-3079
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Country | US
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Telephone | 760-983-4024
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Fax | 760-723-9010
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | SHILO STIGEN
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Credential |
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Telephone | 619-318-4798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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