Healthcare Provider Details

I. General information

NPI: 1003592106
Provider Name (Legal Business Name): KAITLIN STANFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6765 GREEN VALLEY RD
PLACERVILLE CA
95667-8984
US

IV. Provider business mailing address

6765 GREEN VALLEY RD
PLACERVILLE CA
95667-8984
US

V. Phone/Fax

Practice location:
  • Phone: 530-748-3075
  • Fax:
Mailing address:
  • Phone: 530-748-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: