Healthcare Provider Details

I. General information

NPI: 1194656801
Provider Name (Legal Business Name): MICAH STOLFUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10912 JERSEY BLVD
RANCHO CUCAMONGA CA
91730-5102
US

IV. Provider business mailing address

14111 OAKLEY DR
RIVERSIDE CA
92503-7236
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-7789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: