Individual provider · Type 1 NPI

Ethan Stockdale

Student in an Organized Health Care Education/Training Program · Culver City, CA

NPI number 1720810740 Active

Practice location

4760 Sepulveda Blvd
Culver City, CA 90230-4820

Call (310) 390-6612 Map

Mailing address

2051 Glendon Ave
Los Angeles, CA 90025-6323

Specialties and licenses

TaxonomyCodeLicense
Case Manager/Care Coordinator 171M00000XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1720810740

Ethan Stockdale's National Provider Identifier is 1720810740, issued on Aug 19, 2024. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Culver City, CA. The record was last updated on Sep 11, 2024.