Healthcare Provider Details

I. General information

NPI: 1134469281
Provider Name (Legal Business Name): STEPHANIE MARIE STALLA DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 CALLE MARIA
SAN MARCOS CA
92069-2166
US

IV. Provider business mailing address

1202 CALLE MARIA
SAN MARCOS CA
92069-2166
US

V. Phone/Fax

Practice location:
  • Phone: 760-591-9952
  • Fax: 760-591-9977
Mailing address:
  • Phone: 760-591-9952
  • Fax: 760-591-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number19100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: