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General NPI Number Information
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NPI Number | 1437473097
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Entity Type | Individual
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Provider Name | SARAH MICHELLE LEE STACK MD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 106 LA CASA VIA STE 220
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3012
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Country | US
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Telephone | 650-497-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 106 LA CASA VIA STE 220
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3012
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Country | US
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Telephone | 650-497-8000
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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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD60652463
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | A162678
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License Number State | CA
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