MEDICARE: IVETTE STICKELMAIER MD

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	207RR0500X	Rheumatology Physician	A50842	CA

General Provider Information

NPI Number	:	1962430579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVETTE STICKELMAIER MD

Provider Business Mailing Address
First Line	:	5750 DOWNEY AVE
Second Line	:	SUITE 100
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1405
Country	:	US
Telephone Number	:	310-374-6707
Fax Number	:

Provider Business Practice Location Address
First Line	:	5750 DOWNEY AVE
Second Line	:	SUITE 100
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1405
Country	:	US
Telephone Number	:	562-630-3105
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	12/03/2021

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