Provider Demographics
NPI:1356493720
Name:STANLEY, KEN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:ANDREW
Last Name:STANLEY
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 1:5411 AVENIDA ENCINAS
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4409
Mailing Address - Country:US
Mailing Address - Phone:760-529-1504
Mailing Address - Fax:
Practice Address - Street 1:5411 AVENIDA ENCINAS
Practice Address - Street 2:SUITE 100
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4409
Practice Address - Country:US
Practice Address - Phone:760-529-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine