Provider Demographics
NPI:1003093113
Name:STEWART, WILLETTE
Entity Type:Individual
Prefix:MS
First Name:WILLETTE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 EAST IMPERIAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242
Mailing Address - Country:US
Mailing Address - Phone:562-940-3694
Mailing Address - Fax:562-658-4725
Practice Address - Street 1:23759 W VALENCIA BLVD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-253-7271
Practice Address - Fax:661-974-7055
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management