Healthcare Provider Details

I. General information

NPI: 1457959462
Provider Name (Legal Business Name): STEPHANIE MUTILOA ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE POIANI ND

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 LA MESA BLVD # 31
LA MESA CA
91942-0335
US

IV. Provider business mailing address

8030 LA MESA BLVD # 31
LA MESA CA
91942-0335
US

V. Phone/Fax

Practice location:
  • Phone: 619-797-5503
  • Fax:
Mailing address:
  • Phone: 619-797-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: