Basic Information
| Provider Information | |||||||||
| NPI: | 1518097104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | BS IN HUMAN SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3576 ARLINGTON AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925063907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513741555 | ||||||||
| FaxNumber: | 9513947426 | ||||||||
| Practice Location | |||||||||
| Address1: | 3576 ARLINGTON AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925063907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513741555 | ||||||||
| FaxNumber: | 9513947426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.