Basic Information
| Provider Information | |||||||||
| NPI: | 1780639864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOLL | ||||||||
| FirstName: | VICKI-SUE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 ROSSI CIR | ||||||||
| Address2: | SUITE 141 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939072362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317574444 | ||||||||
| FaxNumber: | 8317574419 | ||||||||
| Practice Location | |||||||||
| Address1: | 591 MCCRAY ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950232224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316344444 | ||||||||
| FaxNumber: | 8316344440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 12/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA 12456 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.