Individual provider Active NPI

Stela Georgieva Kostova-Abadjieva, MD

  • Internal Medicine Physician
  • Tustin, CA
National Provider Identifier
1164791265
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A121900 Issued in CA
Practice address
661 W 1St St Ste G
Tustin, CA 92780-2939
Phone
(714) 665-9890
Fax
(714) 665-9891
NPI assigned
Dec 19, 2011
Last updated
Jan 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A121900 CA Primary

Addresses

Primary practice location

661 W 1St St Ste G
Tustin, CA 92780-2939

Mailing address

4310 Orange St
Riverside, CA 92501-3829
Phone (951) 781-6335

Other practice location 1

9918 Katella Ave Ste A-C
Anaheim, CA 92804-6465
Phone (714) 644-9494

Other practice location 2

11180 Warner Ave Ste 353
Fountain Valley, CA 92708-7516
Phone (714) 665-9890 ext. 446

Other identifiers 1

IdentifierTypeStateIssuer
A121900OtherCACA STATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121130000561 CA Practitioner - Internal Medicine 9739331588 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Families Together of Orange County CurrentSince Jan 1, 2023 Accepting new patients
Pioneer Medical Group Inc. CurrentSince Feb 22, 2020 Accepting new patients
Families Together of Orange County CurrentSince Jan 1, 2023 Accepting new patients
Cardiology Specialists Medical Group, Inc. PastSince Oct 1, 2012 Accepting new patients

Locations

9918 Katella Ave
Ste Ac
Anaheim, CA 92804
Phone (714) 644-9494

11180 Warner Ave
Ste 353
Fountain Vly, CA 92708
Phone (714) 751-3540

2220 Clark Ave
Long Beach, CA 90815
Phone (562) 597-4181

661 W 1st St
Ste G
Tustin, CA 92780
Phone (714) 665-9890

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1164791265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 ORANGE ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013829",
            "telephone_number": "951-781-6335",
            "fax_number": "951-781-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 W 1ST ST STE G",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802939",
            "telephone_number": "714-665-9890",
            "fax_number": "714-665-9891"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9918 Katella Ave Ste A-C",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928046465",
            "country_code": "US",
            "telephone_number": "714-644-9494",
            "fax_number": "714-644-9498",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11180 Warner Ave Ste 353",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927087516",
            "country_code": "US",
            "telephone_number": "714-665-9890 x446",
            "fax_number": "714-665-9891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSTOVA-ABADJIEVA",
        "first_name": "STELA",
        "middle_name": "GEORGIEVA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-19",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A121900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA STATE LICENSE",
            "identifier": "A121900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.