Healthcare Provider Details

I. General information

NPI: 1871023358
Provider Name (Legal Business Name): CHERYL STOFFEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 BROAD AVE
WILMINGTON CA
90744-2604
US

IV. Provider business mailing address

1325 BROAD AVE
WILMINGTON CA
90744-2604
US

V. Phone/Fax

Practice location:
  • Phone: 310-404-2080
  • Fax:
Mailing address:
  • Phone: 310-404-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number673739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: