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General NPI Number Information
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NPI Number | 1639995780
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Entity Type | Individual
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Provider Name | DR. JASON VON STIETZ
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Gender | Male
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 25500 HAWTHORNE BLVD STE 25500
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City | TORRANCE
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State | CA
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Zip | 90505-6829
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Country | US
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Telephone | 310-375-4855
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 E 32ND ST APT B
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City | SIGNAL HILL
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State | CA
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Zip | 90755-5128
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 33061
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 33061
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number | 33061
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License Number State | CA
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