Provider Demographics
NPI:1134469281
Name:STALLA, STEPHANIE MARIE (DVM)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:STALLA
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CALLE MARIA
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2166
Mailing Address - Country:US
Mailing Address - Phone:760-591-9952
Mailing Address - Fax:760-591-9977
Practice Address - Street 1:1202 CALLE MARIA
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2166
Practice Address - Country:US
Practice Address - Phone:760-591-9952
Practice Address - Fax:760-591-9977
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19100174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian