Active NPI
Lisa M Stellwagen, M.D.
- Neonatal-Perinatal Medicine Physician
- San Diego, CA
National Provider Identifier
1124055348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal-Perinatal Medicine Physician
- License
- G58014
- Practice address
- 200 W. Arbor Drive
MC 8201
San Diego, CA 92103-8201 - Phone
- (619) 543-6365
- Fax
- (619) 543-3183
- NPI assigned
- Jun 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | G58014 | CA | Primary |
Addresses
Primary practice location
200 W. Arbor Drive
MC 8201
San Diego, CA 92103-8201
Mailing address
200 W Arbor Dr
MC 8774
San Diego, CA 92103-8774
Phone (619) 543-6288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G580140 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G58014 | CA | MD | Neonatal-Perinatal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of California Ucsd Head and Neck Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Otolaryngology Physician
- San Diego, CA
- NPI 1679509962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124055348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 W ARBOR DR",
"address_2": "MC 8774",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921038774",
"telephone_number": "619-543-6288",
"fax_number": "619-543-3812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W. ARBOR DRIVE",
"address_2": "MC 8201",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921038201",
"telephone_number": "619-543-6365",
"fax_number": "619-543-3183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STELLWAGEN",
"first_name": "LISA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "CA",
"license": "G58014",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G580140",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.