Provider Demographics
NPI:1225095375
Name:DAVID H STOLTZMAN MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAVID H STOLTZMAN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:STOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-346-0663
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:STE 409 WRIGHT BLDG
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-346-0663
Mailing Address - Fax:760-346-3523
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:STE 409 WRIGHT BLDG
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-346-0663
Practice Address - Fax:760-346-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G271460Medicaid
A43242Medicare UPIN
CA00G271460Medicaid