Healthcare Provider Details

I. General information

NPI: 1457799207
Provider Name (Legal Business Name): MRS. MARY CORDELIA STELTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14526 GREVILLEA AVE
LAWNDALE CA
90260-1451
US

IV. Provider business mailing address

14526 GREVILLEA AVE
LAWNDALE CA
90260-1451
US

V. Phone/Fax

Practice location:
  • Phone: 310-973-4514
  • Fax:
Mailing address:
  • Phone: 310-973-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94026502
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: