Healthcare Provider Details

I. General information

NPI: 1215181599
Provider Name (Legal Business Name): MS. JEAN L STOLLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRAND AVE
SOUTH SAN FRANCISCO CA
94080-3606
US

IV. Provider business mailing address

301 GRAND AVE
SOUTH SAN FRANCISCO CA
94080-3606
US

V. Phone/Fax

Practice location:
  • Phone: 650-244-1444
  • Fax: 650-244-1447
Mailing address:
  • Phone: 650-244-1444
  • Fax: 650-244-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: