Provider Demographics
NPI:1578115457
Name:STOLLSTEIMER, ANNETTE (LAC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:STOLLSTEIMER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 LATHROP ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1122
Mailing Address - Country:US
Mailing Address - Phone:213-222-7209
Mailing Address - Fax:
Practice Address - Street 1:1416 EL CENTRO ST # 300
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3202
Practice Address - Country:US
Practice Address - Phone:626-403-5018
Practice Address - Fax:626-403-5789
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18537171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist