Provider Demographics
NPI:1689550188
Name:HAZLET, STACHIA LETA
Entity type:Individual
Prefix:
First Name:STACHIA
Middle Name:LETA
Last Name:HAZLET
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 1:3985 WOODSON AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-9659
Mailing Address - Country:US
Mailing Address - Phone:590-282-0963
Mailing Address - Fax:
Practice Address - Street 1:2400 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2802
Practice Address - Country:US
Practice Address - Phone:530-815-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134541390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program