Healthcare Provider Details

I. General information

NPI: 1194402768
Provider Name (Legal Business Name): ZOE ELISE STOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

255 BOWERY APT 3
NEW YORK NY
10002-1201
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-4444
  • Fax: 628-206-4444
Mailing address:
  • Phone: 716-435-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: