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General NPI Number Information
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NPI Number | 1770840167
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Entity Type | Individual
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Provider Name | SIDNEY MORRIS STOLL D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 5901 W OLYMPIC BLVD STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90036-4680
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Country | US
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Telephone | 323-489-6010
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Fax | 833-402-0866
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Provider Business Mailing Address
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Address Line | 541 W COLORADO ST STE 205
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City | GLENDALE
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State | CA
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Zip | 91204-3640
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Country | US
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Telephone | 323-254-0046
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Fax | 323-488-9782
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 20A16313
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License Number State | CA
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