# D STARKS MD INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154555795
- **Authorized official:** DR. D'MITRI STARKS MD (CEO)
- **Authorized official phone:** (909) 625-0661

## Contact information

- **Practice address:** 5153 HOLT BLVD, SUITE B-2, MONTCLAIR, CA 91763-4837
- **Practice address phone:** (909) 625-0661
- **Practice address fax:** (909) 625-7761
- **Mailing address:** 5153 HOLT BLVD, SUITE B-2, MONTCLAIR, CA 91763-4837
- **Mailing address phone:** (909) 625-0661
- **Mailing address fax:** (909) 625-7761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G49823 | CA | Yes |

## Other

- **Enumeration date:** 05/12/2009
- **Last updated:** 05/12/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G498230 | — | CA |