Provider Demographics
NPI:1386086635
Name:ARNOLD, STACY J (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:J
Last Name:ARNOLD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20001 S RANCHO WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6318
Mailing Address - Country:US
Mailing Address - Phone:310-225-3221
Mailing Address - Fax:310-698-7040
Practice Address - Street 1:20001 S RANCHO WAY
Practice Address - Street 2:
Practice Address - City:RANCHO DOMINGUEZ
Practice Address - State:CA
Practice Address - Zip Code:90220-6318
Practice Address - Country:US
Practice Address - Phone:310-225-3221
Practice Address - Fax:310-698-7040
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC195262207ZP0102X
AZ53784207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC195262Medicaid
AZR74021OtherARIZONA MEDICAL BOARD
AZ459218Medicaid