Provider Demographics
NPI:1477584787
Name:STELLAR, SEAN LELAND (CPO)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:LELAND
Last Name:STELLAR
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 S ARROYO PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3902
Mailing Address - Country:US
Mailing Address - Phone:626-584-0805
Mailing Address - Fax:626-584-0806
Practice Address - Street 1:753 S ARROYO PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3902
Practice Address - Country:US
Practice Address - Phone:626-584-0805
Practice Address - Fax:626-584-0806
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXC0001829Medicaid
CAXC0001829Medicaid