Healthcare Provider Details

I. General information

NPI: 1295963569
Provider Name (Legal Business Name): STEPHANIE JONES STOUTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 E WASHINGTON BLVD
COMMERCE CA
90040-2449
US

IV. Provider business mailing address

1220 E 67TH ST
LOS ANGELES CA
90001-1627
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0960
  • Fax:
Mailing address:
  • Phone: 323-652-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: