Individual
STELLA MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
320 TESCONI CIR STE G, SANTA ROSA, CA 95401-4611
(707) 544-2637
(707) 544-2088
Mailing address
320 TESCONI CIR STE G, SANTA ROSA, CA 95401-4611
(707) 544-2637
(707) 544-2088
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA2154
CA
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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