Healthcare Provider Details

I. General information

NPI: 1629984745
Provider Name (Legal Business Name): ROBERT B STOUTEMIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40925 COUNTY CENTER DR
TEMECULA CA
92591-6054
US

IV. Provider business mailing address

40925 COUNTY CENTER DR 28793 VELA DR, MENIFEE, CA 92586
TEMECULA CA
92591-6054
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-6300
  • Fax: 951-600-6300
Mailing address:
  • Phone: 951-600-6300
  • Fax: 951-600-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: