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General NPI Number Information
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NPI Number | 1720668593
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Entity Type | Individual
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Provider Name | KELLI STAGER
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Gender | Female
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 6167 BRISTOL PKWY STE 260
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City | CULVER CITY
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State | CA
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Zip | 90230-6616
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Country | US
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Telephone | 424-331-5604
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Fax | 424-331-5600
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Provider Business Mailing Address
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Address Line | 3100 OAK RD STE 270
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City | WALNUT CREEK
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State | CA
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Zip | 94597-2078
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Country | US
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Telephone | 925-944-9711
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Fax | 424-331-5600
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A183161
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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