Provider Demographics
NPI:1568769412
Name:FRED J VON STIEFF MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FRED J VON STIEFF MD A PROFESSIONAL CORPORATION
Other - Org Name:VON STIEFF MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL MONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-680-8933
Mailing Address - Street 1:2481 PACHECO ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2019
Mailing Address - Country:US
Mailing Address - Phone:925-680-8933
Mailing Address - Fax:
Practice Address - Street 1:2481 PACHECO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2019
Practice Address - Country:US
Practice Address - Phone:925-680-8933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34928207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty