Provider Demographics
NPI:1891735676
Name:AMBO, STANLEY G (MD)
Entity Type:Individual
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First Name:STANLEY
Middle Name:G
Last Name:AMBO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-836-4319
Practice Address - Street 1:2067 W. VISTA WAY
Practice Address - Street 2:SUITE 180
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6033
Practice Address - Country:US
Practice Address - Phone:760-945-3434
Practice Address - Fax:760-945-6761
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-09-10
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Provider Licenses
StateLicense IDTaxonomies
CAG77814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G778140Medicaid