Provider Demographics
NPI:1164494696
Name:BURSTEN, STUART LOWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LOWELL
Last Name:BURSTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-554-1212
Mailing Address - Fax:858-795-1195
Practice Address - Street 1:204 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084
Practice Address - Country:US
Practice Address - Phone:760-941-8888
Practice Address - Fax:858-795-1195
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA82454OtherSTATE MEDICAL LICENSE
CAF40866Medicare UPIN
CA00G861250Medicare ID - Type UnspecifiedMEDICARE NUMBER