Provider Demographics
NPI:1851516694
Name:ELIZABETH A STELZ DO INC
Entity Type:Organization
Organization Name:ELIZABETH A STELZ DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:STELZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-926-1338
Mailing Address - Street 1:101 OLD MCCLOUD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2796
Mailing Address - Country:US
Mailing Address - Phone:530-926-1338
Mailing Address - Fax:
Practice Address - Street 1:101 OLD MCCLOUD RD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2796
Practice Address - Country:US
Practice Address - Phone:530-926-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG1303OtherRAILROAD MEDICARE
CA00AX79230Medicaid
CAZZZ05108ZMedicare PIN
CA00AX79230Medicaid