Provider Demographics
NPI:1235380361
Name:STEWART, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 AMESTOY AVE
Mailing Address - Street 2:14414 DELANO ST.
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3202
Mailing Address - Country:US
Mailing Address - Phone:818-374-2848
Mailing Address - Fax:818-909-6719
Practice Address - Street 1:14414 DELANO ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2703
Practice Address - Country:US
Practice Address - Phone:818-374-2848
Practice Address - Fax:818-909-6719
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAU5030771171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator