Provider Demographics
NPI:1679523518
Name:WILLGING, STEFAN A (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:A
Last Name:WILLGING
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 1:4060 4TH AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-298-1311
Mailing Address - Fax:619-298-0843
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-298-1311
Practice Address - Fax:619-298-0843
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086930Medicaid
CAW14788Medicare ID - Type Unspecified
H90904Medicare UPIN