Healthcare Provider Details

I. General information

NPI: 1205176484
Provider Name (Legal Business Name): ESTHER A STANCZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 KURTZ ST
SAN DIEGO CA
92110-4430
US

IV. Provider business mailing address

3491 KURTZ ST
SAN DIEGO CA
92110-4430
US

V. Phone/Fax

Practice location:
  • Phone: 619-320-2404
  • Fax:
Mailing address:
  • Phone: 619-320-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: