Provider Demographics
NPI:1922184076
Name:POLLACK, STELLA D (MD)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:D
Last Name:POLLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STELLA
Other - Middle Name:GUTIERREZ
Other - Last Name:DE DIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3195 HARBOR BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2514
Mailing Address - Country:US
Mailing Address - Phone:714-263-0227
Mailing Address - Fax:714-263-0231
Practice Address - Street 1:3195 HARBOR BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2514
Practice Address - Country:US
Practice Address - Phone:714-263-0227
Practice Address - Fax:714-263-0231
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D34094Medicare UPIN