MEDICARE: JONATHAN STOLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	162775	CA

General Provider Information

NPI Number	:	1942135660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN STOLL

Provider Business Mailing Address
First Line	:	645 COUNTRY CLUB DR APT 818
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-7609
Country	:	US
Telephone Number	:	818-967-8988
Fax Number	:

Provider Business Practice Location Address
First Line	:	2565 ALHAMBRA CT
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-9326
Country	:	US
Telephone Number	:	818-967-8988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ JONATHAN STOLL ” Practice Location

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