Individual
STACY RENEE DIMARTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16451 LAWSON VALLEY RD, JAMUL, CA 91935-2413
(619) 246-1551
Mailing address
16451 LAWSON VALLEY RD, JAMUL, CA 91935-2413
(619) 246-1551
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B4459050
DRIVER LICENSE
CA
Enumeration date
03/08/2022
Last updated
03/09/2022
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