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NPI Code Detail

MEDICARE: MARY STAHOVICH

MEDICARE: MARY STAHOVICH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1649346495
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY STAHOVICH
Provider Business Mailing Address
First Line : 1760 CHICAGO AVE STE J3
Second Line : U.S. HEALTHWORKS, RIVERSIDE FACILITY #345
City : RIVERSIDE
State : CA
Zip : 92507-2358
Country : US
Telephone Number : 951-781-2200
Fax Number : 951-781-2220
Provider Business Practice Location Address
First Line : 1760 CHICAGO AVE STE J3
Second Line : U.S. HEALTHWORKS, RIVERSIDE FACILITY #345
City : RIVERSIDE
State : CA
Zip : 92507-2358
Country : US
Telephone Number : 951-781-2200
Fax Number : 951-781-2220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2006
Last Update Date : 07/08/2007

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Directions to “ MARY STAHOVICH ” Practice Location

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