Healthcare Provider Details

I. General information

NPI: 1659639417
Provider Name (Legal Business Name): ADAM STELLING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2374 E PACIFICA PL
RANCHO DOMINGUEZ CA
90220
US

IV. Provider business mailing address

2374 E PACIFICA PL
RANCHO DOMINGUEZ CA
90220-6214
US

V. Phone/Fax

Practice location:
  • Phone: 310-225-3244
  • Fax: 310-698-7040
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-698-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA130440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: