Healthcare Provider Details

I. General information

NPI: 1871401588
Provider Name (Legal Business Name): HAILEY ANN STOLLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S MOLLISON AVE
EL CAJON CA
92020-7735
US

IV. Provider business mailing address

5040 COMANCHE DR APT 47
LA MESA CA
91942-8129
US

V. Phone/Fax

Practice location:
  • Phone: 619-201-8372
  • Fax:
Mailing address:
  • Phone: 714-290-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: