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General NPI Number Information
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NPI Number | 1124119227
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Entity Type | Individual
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Provider Name | STEFANIE MAYER PT
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 1333 WILLOW PASS RD STE 110
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City | CONCORD
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State | CA
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Zip | 94520-5225
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Country | US
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Telephone | 925-732-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 CORTE DEL NOGAL STE 200
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City | CARLSBAD
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State | CA
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Zip | 92011-1445
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 018887-1
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License Number State | NY
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