Provider Demographics
NPI:1730326430
Name:STAHL, JEFFREY A (OTC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:STAHL
Suffix:
Gender:M
Credentials:OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7485 MISSION VALLEY RD
Mailing Address - Street 2:SUITE 104 A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4422
Mailing Address - Country:US
Mailing Address - Phone:619-291-8930
Mailing Address - Fax:619-398-4989
Practice Address - Street 1:7485 MISSION VALLEY RD
Practice Address - Street 2:SUITE 104 A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4422
Practice Address - Country:US
Practice Address - Phone:619-291-8930
Practice Address - Fax:619-398-4989
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA081123247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other