Provider Demographics
NPI:1972536399
Name:CORNERSTONE MEDICAL SERVICES INC
Entity type:Organization
Organization Name:CORNERSTONE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-0578
Mailing Address - Street 1:4312 WOODMAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-5546
Mailing Address - Country:US
Mailing Address - Phone:213-977-0578
Mailing Address - Fax:213-977-0653
Practice Address - Street 1:4312 WOODMAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-5546
Practice Address - Country:US
Practice Address - Phone:213-977-0578
Practice Address - Fax:213-977-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty