Provider Demographics
NPI:1598307852
Name:DIFAZIO, STACI ANN (RN)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:ANN
Last Name:DIFAZIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:DIFAZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:24455 MONTEVISTA CIR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1221
Mailing Address - Country:US
Mailing Address - Phone:818-588-9389
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:747-210-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA808709163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health