Provider Demographics
NPI:1780108381
Name:MICHAEL JAROSLAV STASTNY, DPM, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL JAROSLAV STASTNY, DPM, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAROSLAV
Authorized Official - Last Name:STASTNY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-334-5795
Mailing Address - Street 1:576 ARCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2707
Mailing Address - Country:US
Mailing Address - Phone:714-334-5795
Mailing Address - Fax:
Practice Address - Street 1:3180 COLIMA RD STE A
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6315
Practice Address - Country:US
Practice Address - Phone:626-961-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5216213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty