Healthcare Provider Details

I. General information

NPI: 1861691834
Provider Name (Legal Business Name): JODY ANN STAYER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JODY ANN REDIGER

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 SANTA ANITA AVE
EL MONTE CA
91731-1611
US

IV. Provider business mailing address

1515 E KATELLA AVE UNIT 3150
ANAHEIM CA
92805-6680
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-6793
  • Fax: 626-797-7722
Mailing address:
  • Phone: 714-613-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 55885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: