Healthcare Provider Details

I. General information

NPI: 1790062404
Provider Name (Legal Business Name): VICTORIA RAE STIGALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H100 SANTA MARGARITA ROAD ATTENTION: CODE 094 NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

H100 SANTA MARGARITA ROAD ATTENTION: CODE 094 NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1516
  • Fax: 760-725-1238
Mailing address:
  • Phone: 760-725-1516
  • Fax: 760-725-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2198
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: