Individual
JULIE NICOLE STASSART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
762 CYPRESS ST, SAN DIMAS, CA 91773-3505
(909) 599-1227
(909) 542-0210
Mailing address
762 CYPRESS ST, SAN DIMAS, CA 91773-3505
(909) 599-1227
(909) 542-0210
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/13/2007
Last updated
12/13/2007
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