Provider Demographics
NPI:1043699754
Name:STOUT, ARACELI (64440)
Entity Type:Individual
Prefix:DR
First Name:ARACELI
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:64440
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4762 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3026
Mailing Address - Country:US
Mailing Address - Phone:951-496-5637
Mailing Address - Fax:
Practice Address - Street 1:4762 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3026
Practice Address - Country:US
Practice Address - Phone:951-496-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist