Provider Demographics
NPI:1851506851
Name:STAMPLER, FREDERICK M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:STAMPLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4926
Mailing Address - Country:US
Mailing Address - Phone:310-472-3622
Mailing Address - Fax:
Practice Address - Street 1:12011 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4926
Practice Address - Country:US
Practice Address - Phone:310-472-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL80850OtherBLUE SHIELD OF CALIFORNIA
CA149016OtherVALUE OPTIONS
CA149016OtherVALUE OPTIONS