1235390675 NPI number — STUART KRAMER MD A MEDICAL CORP

Table of content: ROBERT W. REIDY M.D. (NPI 1245226455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235390675 NPI number — STUART KRAMER MD A MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STUART KRAMER MD A MEDICAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235390675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19730 VENTURA BLVD # 3104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91364-2625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-716-5179
Provider Business Mailing Address Fax Number:
818-716-5179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 4TH AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-293-3995
Provider Business Practice Location Address Fax Number:
619-295-5863
Provider Enumeration Date:
06/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
STUART
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
619-293-3995

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  G18896 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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