Healthcare Provider Details

I. General information

NPI: 1487160784
Provider Name (Legal Business Name): JESSICA STELLITANO PEER SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PRESLEY AVE
RIVERSIDE CA
92507-4453
US

IV. Provider business mailing address

3525 PRESLEY AVE
RIVERSIDE CA
92507-4453
US

V. Phone/Fax

Practice location:
  • Phone: 951-313-9488
  • Fax:
Mailing address:
  • Phone: 951-313-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPYFXWJVQODESIATH
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: