Provider Demographics
NPI:1184986226
Name:PODER, DAVID STANLEY (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:STANLEY
Last Name:PODER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6289 PACIFIC POINTE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-7522
Mailing Address - Country:US
Mailing Address - Phone:714-849-1826
Mailing Address - Fax:714-374-7438
Practice Address - Street 1:6289 PACIFIC POINTE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-7522
Practice Address - Country:US
Practice Address - Phone:714-849-1826
Practice Address - Fax:714-374-7438
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4153208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice