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General NPI Number Information
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NPI Number | 1790787141
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Entity Type | Individual
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Provider Name | JONATHAN R STELLA MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 100 CASA ST SUITE C
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1883
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Country | US
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Telephone | 805-541-1932
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Fax | 805-541-1653
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Provider Business Mailing Address
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Address Line | PO BOX 849697
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City | LOS ANGELES
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State | CA
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Zip | 90084-9697
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Country | US
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Telephone | 805-648-5191
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Fax | 805-648-3458
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | A43943
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License Number State | CA
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