Healthcare Provider Details

I. General information

NPI: 1063679934
Provider Name (Legal Business Name): STACEY TROST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16756 SEPTO ST
NORTH HILLS CA
91343-1043
US

IV. Provider business mailing address

16756 SEPTO ST
NORTH HILLS CA
91343-1043
US

V. Phone/Fax

Practice location:
  • Phone: 917-331-0983
  • Fax:
Mailing address:
  • Phone: 917-331-0983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number10774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: