Individual
THEODORE ROGER STOVALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9229 CONDESA DR, SACRAMENTO, CA 95826-5241
(916) 208-1950
Mailing address
9229 CONDESA DR, SACRAMENTO, CA 95826-5241
(916) 208-1950
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
CA
Other
Enumeration date
02/22/2023
Last updated
02/22/2023
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