Provider Demographics
NPI:1699062083
Name:FREDERICK L.STAFFORD M.D., INC.
Entity type:Organization
Organization Name:FREDERICK L.STAFFORD M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALUD
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:562-427-1322
Mailing Address - Street 1:25431 CABOT RD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5526
Mailing Address - Country:US
Mailing Address - Phone:562-427-1322
Mailing Address - Fax:562-427-2255
Practice Address - Street 1:25431 CABOT RD STE 107
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5526
Practice Address - Country:US
Practice Address - Phone:562-427-1322
Practice Address - Fax:562-427-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty