Healthcare Provider Details

I. General information

NPI: 1750274239
Provider Name (Legal Business Name): JUSTIN STOKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PACIFIC ST
MONTEREY CA
93940-2815
US

IV. Provider business mailing address

3136 MESSINGER DR
MARINA CA
93933-2813
US

V. Phone/Fax

Practice location:
  • Phone: 831-645-1261
  • Fax:
Mailing address:
  • Phone: 831-917-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number78A7310394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: