Basic Information
| Provider Information | |||||||||
| NPI: | 1376667758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOFFLE | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 INDIAN CREEK DR APT B | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331404706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057201473 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9000 SW 137TH AVE STE 116 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331861435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053829991 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 20476 | FL | Y | Other Service Providers | Specialist |
No ID Information.