Provider Demographics
NPI:1427196310
Name:STEPHEN A. CENTER, MD INC.
Entity Type:Organization
Organization Name:STEPHEN A. CENTER, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-277-8600
Mailing Address - Street 1:4320 GENESEE AVE
Mailing Address - Street 2:202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4900
Mailing Address - Country:US
Mailing Address - Phone:858-277-8600
Mailing Address - Fax:858-277-0300
Practice Address - Street 1:4320 GENESEE AVE
Practice Address - Street 2:202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4900
Practice Address - Country:US
Practice Address - Phone:858-277-8600
Practice Address - Fax:858-277-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47034Medicare UPIN