Provider Demographics
NPI:1265968788
Name:STUMP, CHARI DIANA (MD)
Entity type:Individual
Prefix:
First Name:CHARI
Middle Name:DIANA
Last Name:STUMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11280 VISTA SORRENTO PKWY APT 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-7638
Mailing Address - Country:US
Mailing Address - Phone:301-908-6519
Mailing Address - Fax:
Practice Address - Street 1:7910 FROST ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2753
Practice Address - Country:US
Practice Address - Phone:858-495-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0089953208M00000X
CAA173107208000000X
VA0101269267208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist