Provider Demographics
NPI:1710003553
Name:STOLTZ, STEVEN LOUIS (MA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LOUIS
Last Name:STOLTZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14600 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3363
Mailing Address - Country:US
Mailing Address - Phone:626-337-8811
Mailing Address - Fax:626-856-5653
Practice Address - Street 1:14600 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3363
Practice Address - Country:US
Practice Address - Phone:626-337-8811
Practice Address - Fax:626-856-5653
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007302Medicaid