Provider Demographics
NPI:1083927545
Name:STANLEY, MARIA L
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:L
Last Name:STANLEY
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 1:260 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6216
Mailing Address - Country:US
Mailing Address - Phone:209-381-1170
Mailing Address - Fax:209-381-1173
Practice Address - Street 1:260 E 15TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6216
Practice Address - Country:US
Practice Address - Phone:209-381-1170
Practice Address - Fax:209-381-1173
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker