Provider Demographics
NPI:1033306501
Name:SANMIGUEL, STACIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:
Last Name:SANMIGUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR # MC-0039
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-5004
Mailing Address - Country:US
Mailing Address - Phone:858-822-4757
Mailing Address - Fax:858-534-7545
Practice Address - Street 1:9500 GILMAN DR # MC-0039
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-5004
Practice Address - Country:US
Practice Address - Phone:858-822-4757
Practice Address - Fax:858-534-7545
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine