Provider Demographics
NPI:1437188976
Name:STANLEY, JULIAN B (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:B
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:PO BOX 15125
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-1125
Mailing Address - Country:US
Mailing Address - Phone:310-247-9457
Mailing Address - Fax:310-247-9458
Practice Address - Street 1:111 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6861
Practice Address - Country:US
Practice Address - Phone:310-379-2134
Practice Address - Fax:310-379-4856
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46619207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A466190Medicaid
CAWA46619EMedicare PIN
CAWA46619DMedicare PIN