MEDICARE: VICKI-SUE STOLL PA

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
1	363A00000X	Physician Assistant	PA 12456	CA

General Provider Information

NPI Number	:	1780639864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI-SUE STOLL PA

Provider Business Mailing Address
First Line	:	4 ROSSI CIR
Second Line	:	SUITE 141
City	:	SALINAS
State	:	CA
Zip	:	93907-2362
Country	:	US
Telephone Number	:	831-757-4444
Fax Number	:	831-757-4419

Provider Business Practice Location Address
First Line	:	591 MCCRAY ST
Second Line	:	SUITE 101
City	:	HOLLISTER
State	:	CA
Zip	:	95023-2224
Country	:	US
Telephone Number	:	831-634-4444
Fax Number	:	831-634-4440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	12/29/2009

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Directions to “ VICKI-SUE STOLL PA” Practice Location

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