Healthcare Provider Details

I. General information

NPI: 1750834677
Provider Name (Legal Business Name): MONICA STAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 S BUENA VISTA ST
BURBANK CA
91505-4504
US

IV. Provider business mailing address

223 DEVONSHIRE BLVD
SAN CARLOS CA
94070-1638
US

V. Phone/Fax

Practice location:
  • Phone: 818-748-4717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: