Provider Demographics
NPI:1649411646
Name:STOEFEN, SHERRY LEE
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:STOEFEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:916-394-2320
Mailing Address - Fax:916-394-2453
Practice Address - Street 1:4241 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2535
Practice Address - Country:US
Practice Address - Phone:916-394-2320
Practice Address - Fax:916-394-2453
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311889261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA311899OtherOUT PATIENT DRUG AND ALOCHOL TREATMENT