Provider Demographics
NPI:1376757625
Name:E. STANLEY RODIER, M.D.,FRCPC,INC
Entity Type:Organization
Organization Name:E. STANLEY RODIER, M.D.,FRCPC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEMMLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-258-6200
Mailing Address - Street 1:15725 POMERADO RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2068
Mailing Address - Country:US
Mailing Address - Phone:858-485-8111
Mailing Address - Fax:858-485-9926
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 108
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-485-8111
Practice Address - Fax:858-485-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33957207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17845Medicare ID - Type Unspecified