Provider Demographics
NPI:1346366929
Name:MARK S STERN M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARK S STERN M D A PROFESSIONAL CORPORATION
Other - Org Name:SOUTHERN CALIFORNIA INSTITUTE OF NEUROLOGICAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-489-9490
Mailing Address - Street 1:705 E OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3418
Mailing Address - Country:US
Mailing Address - Phone:760-489-9490
Mailing Address - Fax:760-489-7638
Practice Address - Street 1:705 E OHIO AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3418
Practice Address - Country:US
Practice Address - Phone:760-489-9490
Practice Address - Fax:760-489-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47596207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649282765OtherINDIVIDUAL NPI