Provider Demographics
NPI:1528157658
Name:STOLTZFUS, DONALD LEE (PH D)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:STOLTZFUS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 OCEAN VIEW BLVD
Mailing Address - Street 2:STE K
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1573
Mailing Address - Country:US
Mailing Address - Phone:818-240-8295
Mailing Address - Fax:818-249-0775
Practice Address - Street 1:3429 OCEAN VIEW BLVD
Practice Address - Street 2:STE K
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1536
Practice Address - Country:US
Practice Address - Phone:818-240-8295
Practice Address - Fax:818-249-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8607103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8607Medicare ID - Type Unspecified