Provider Demographics
NPI:1922621234
Name:STADTMAN, JASSEN AGUIRRE (RPT)
Entity Type:Individual
Prefix:
First Name:JASSEN
Middle Name:AGUIRRE
Last Name:STADTMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6097 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2935
Mailing Address - Country:US
Mailing Address - Phone:925-464-6717
Mailing Address - Fax:
Practice Address - Street 1:5318 MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0512
Practice Address - Country:US
Practice Address - Phone:913-331-8513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist