Provider Demographics
NPI:1093465999
Name:STARK, PHOEBE CATHERINE
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:CATHERINE
Last Name:STARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 GARNET AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3768
Mailing Address - Country:US
Mailing Address - Phone:865-208-2167
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DRIVE
Practice Address - Street 2:MC 8894
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1911
Practice Address - Country:US
Practice Address - Phone:858-657-8200
Practice Address - Fax:858-657-8269
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program