Individual
STACI JAE SKREDERSTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LE
Contact information
Practice address
2032 THOMPSON CT STE 12, MONTROSE, CA 91020-1652
(818) 249-5489
Mailing address
427 N 7TH ST, MONTEBELLO, CA 90640-4211
(818) 383-8278
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
L9882
CA
Other
Enumeration date
09/14/2024
Last updated
09/14/2024
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