MEDICARE: GARY W STABLEIN MD MBA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1689406092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY W STABLEIN MD MBA INC

Provider Business Mailing Address
First Line	:	5904 WARNER AVE UNIT 426
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4670
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5904 WARNER AVE UNIT 426
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4670
Country	:	US
Telephone Number	:	949-889-2971
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. GARY WILLIAMS STABLEIN
Credential	:	MD, MBA
Telephone Number	:	949-889-2971

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/14/2024

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