Provider Demographics
NPI:1245941095
Name:STOUGH, SAMANTHA (RD, CSG)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:STOUGH
Suffix:
Gender:F
Credentials:RD, CSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 PLUMAS BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-5075
Mailing Address - Country:US
Mailing Address - Phone:530-749-2409
Mailing Address - Fax:530-751-4973
Practice Address - Street 1:481 PLUMAS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5075
Practice Address - Country:US
Practice Address - Phone:530-749-2409
Practice Address - Fax:530-751-4973
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86014476133V00000X
CA86014476133VN1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered