Provider Demographics
NPI:1891744520
Name:NAIDES, STANLEY J (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:J
Last Name:NAIDES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:33608 ORTEGA HWY
Mailing Address - Street 2:IMMUNOLOGY 101A
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2042
Mailing Address - Country:US
Mailing Address - Phone:949-728-4578
Mailing Address - Fax:949-728-7852
Practice Address - Street 1:33608 ORTEGA HWY
Practice Address - Street 2:IMMUNOLOGY 101A
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2042
Practice Address - Country:US
Practice Address - Phone:949-728-4578
Practice Address - Fax:949-728-7852
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-01-09
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Provider Licenses
StateLicense IDTaxonomies
PAMD023098E207RR0500X
CAG44992207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A03005Medicare UPIN
A03005Medicare UPIN
PA0017761730001Medicaid