Heidi Stout, RDN

Individual provider Active NPI Registered Dietitian · Pinon Hills, CA

NPI 1265057012 · NPPES record last updated Jun 8, 2020

Key facts

NPI
1265057012
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
1020603 (CA)
Practice address
9948 Oasis Rd
Pinon Hills, CA 92372
Phone
(760) 912-9371
NPI assigned
Jun 8, 2020
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1020603CAMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 1020603 CA Yes

Addresses

Primary practice location

9948 Oasis Rd
Pinon Hills, CA 92372

Mailing address

PO Box 721204
Pinon Hills, CA 92372-1204
Phone (760) 912-9371

Other providers in Pinon Hills, CA

All providers in Pinon Hills, CA · Registered Dietitian in California

Sources for this page

Verify at the official NPI Registry.