Healthcare Provider Details

I. General information

NPI: 1003212697
Provider Name (Legal Business Name): DUANE STIGEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 BEACH COURT
LOTUS CA
95651
US

IV. Provider business mailing address

838 BEACH COURT
LOTUS CA
95651
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-7252
  • Fax: 530-626-7934
Mailing address:
  • Phone: 530-626-7252
  • Fax: 530-626-7934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13827
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI06960217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: