Provider Demographics
NPI:1639276819
Name:STEMMLE,STEMMLE, ROSE AND AHMED
Entity Type:Organization
Organization Name:STEMMLE,STEMMLE, ROSE AND AHMED
Other - Org Name:ALTA VISTA PEDIATRIC MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEMMLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-2755
Mailing Address - Street 1:2577 SAMARITAN DR
Mailing Address - Street 2:SUITE # 725
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4100
Mailing Address - Country:US
Mailing Address - Phone:408-358-2755
Mailing Address - Fax:408-358-2548
Practice Address - Street 1:2577 SAMARITAN DR
Practice Address - Street 2:SUITE # 725
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4100
Practice Address - Country:US
Practice Address - Phone:408-358-2755
Practice Address - Fax:408-358-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN