1528065810 NPI number — LAURA STAMPLEMAN M.D

Table of content: LAURA STAMPLEMAN M.D (NPI 1528065810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528065810 NPI number — LAURA STAMPLEMAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAMPLEMAN
Provider First Name:
LAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528065810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 HARRIS CT
Provider Second Line Business Mailing Address:
BUILDING T, SUITE 201
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-5750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-375-4105
Provider Business Mailing Address Fax Number:
831-372-5722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 HARRIS COURT, BUILDING T
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-375-4105
Provider Business Practice Location Address Fax Number:
831-372-5722
Provider Enumeration Date:
07/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  G60252 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G602520 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CP784X . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 110023693 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".