Provider Demographics
NPI:1326098070
Name:SOUDERS, STUART A (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:SOUDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 WARNER AVE
Mailing Address - Street 2:SUITE 151
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4659
Mailing Address - Country:US
Mailing Address - Phone:714-717-7154
Mailing Address - Fax:
Practice Address - Street 1:5901 WARNER AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4659
Practice Address - Country:US
Practice Address - Phone:714-717-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39838174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C398380Medicaid
CAWC39838LMedicare PIN
CAZZZ03726ZMedicare PIN
CAW16629Medicare PIN
CAW4653Medicare PIN
CAA88139Medicare UPIN
CA00C398380Medicaid