Provider Demographics
NPI:1992730352
Name:STUNJA, JOHN ANTHONY (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:STUNJA
Suffix:
Gender:M
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 ANZIO ST # A
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-2405
Mailing Address - Country:US
Mailing Address - Phone:760-386-0835
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 166 INNER LOOP ROAD
Practice Address - Street 2:WEED ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05475133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered