Provider Demographics
NPI:1609417948
Name:TILLMAN, STELLA YEVETTE (STELLA ADAMS)
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:YEVETTE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:STELLA ADAMS
Other - Prefix:MRS
Other - First Name:STELLA
Other - Middle Name:YVETTE
Other - Last Name:TILLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RADT
Mailing Address - Street 1:4241 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2535
Mailing Address - Country:US
Mailing Address - Phone:916-628-8740
Mailing Address - Fax:916-453-2707
Practice Address - Street 1:3600 POWER INN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3826
Practice Address - Country:US
Practice Address - Phone:916-628-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR13203908182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer