Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | C153751 | CA |
NPI | 1730128513 |
---|---|
Provider Name | Dr. William David Stanley |
First Address | Malibu, CA 90265-4825 |
Second Address | Malibu, CA 90265-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 28/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C55911 | (02) | NJ |