Individual
DR. JOHN STANLEY SUPANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
26726 CROWN VALLEY PKWY, #200, MISSION VIEJO, CA 92691-6364
(949) 364-4361
(949) 364-4495
Mailing address
26726 CROWN VALLEY PKWY, #200, MISSION VIEJO, CA 92691-6364
(949) 364-4361
(949) 364-4495
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G50560
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G505600
—
CA
Enumeration date
06/24/2006
Last updated
09/20/2007
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