Provider Demographics
NPI:1336952126
Name:MAILLIS, STELLA
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:MAILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W PLACITA DE LA POZA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4743
Mailing Address - Country:US
Mailing Address - Phone:575-776-7881
Mailing Address - Fax:
Practice Address - Street 1:9950 N WILD CREEK DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85742-8400
Practice Address - Country:US
Practice Address - Phone:575-776-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30344225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist