Provider Demographics
NPI:1205125275
Name:MALGORZATA STANCZYK MD INC
Entity type:Organization
Organization Name:MALGORZATA STANCZYK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-756-4386
Mailing Address - Street 1:1536 W 25TH ST
Mailing Address - Street 2:#208
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4415
Mailing Address - Country:US
Mailing Address - Phone:310-756-4386
Mailing Address - Fax:310-326-3744
Practice Address - Street 1:432 E 10TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4424
Practice Address - Country:US
Practice Address - Phone:310-756-4386
Practice Address - Fax:310-326-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA101481OtherSTATE LICENSE OF PRESIDENT