Active NPI
Staci Jae Skrederstu, LE
- Other Specialist/Technologist
- Montrose, CA
National Provider Identifier
1285461376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- License
- L9882
- Practice address
- 2032 Thompson CT Ste 12
Montrose, CA 91020-1652 - Phone
- (818) 249-5489
- NPI assigned
- Sep 14, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Specialist/Technologist | 246Z00000X | L9882 | CA | Primary |
Addresses
Primary practice location
2032 Thompson CT Ste 12
Montrose, CA 91020-1652
Mailing address
427 N 7TH St
Montebello, CA 90640-4211
Phone (818) 383-8278
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L9882 | CA | MD | Other Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726272000000",
"number": "1285461376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "427 N 7TH ST",
"city": "MONTEBELLO",
"state": "CA",
"postal_code": "906404211",
"telephone_number": "818-383-8278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2032 THOMPSON CT STE 12",
"city": "MONTROSE",
"state": "CA",
"postal_code": "910201652",
"telephone_number": "818-249-5489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKREDERSTU",
"first_name": "STACI",
"middle_name": "JAE",
"credential": "LE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-14",
"last_updated": "2024-09-14",
"certification_date": "2024-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": "CA",
"license": "L9882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montrose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.