Provider Demographics
NPI: | 1598008583 |
---|---|
Name: | STEWART L. FRANK MD, INC. |
Entity Type: | Organization |
Organization Name: | STEWART L. FRANK MD, INC. |
Other - Org Name: | DR. STEWART FRANK, INC. |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SCOTT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PETERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 858-625-2990 |
Mailing Address - Street 1: | 9276 SCRANTON RD |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | SAN DIEGO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92121-7701 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4060 4TH AVE |
Practice Address - Street 2: | SUITE 605 |
Practice Address - City: | SAN DIEGO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92103-2116 |
Practice Address - Country: | US |
Practice Address - Phone: | 619-296-7014 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MEDVANTX, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2013-03-28 |
Last Update Date: | 2017-01-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | G26854 | 332900000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332900000X | Suppliers | Non-Pharmacy Dispensing Site |