Provider Demographics
NPI:1376943514
Name:STAMBAUGH, CATHY JEAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:JEAN
Last Name:STAMBAUGH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:CATHY
Other - Middle Name:JEAN
Other - Last Name:MILCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:232 E GISH RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4706
Mailing Address - Country:US
Mailing Address - Phone:408-453-7616
Mailing Address - Fax:
Practice Address - Street 1:232 E GISH RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4706
Practice Address - Country:US
Practice Address - Phone:408-453-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator