1457677874 NPI number — STANLEY L. STOCK, M. D., INC.

Table of content: (NPI 1457677874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457677874 NPI number — STANLEY L. STOCK, M. D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANLEY L. STOCK, M. D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457677874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1428 W 7TH ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN PEDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90732-3523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-833-5221
Provider Business Mailing Address Fax Number:
310-833-4022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1428 W 7TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-833-5221
Provider Business Practice Location Address Fax Number:
310-833-4022
Provider Enumeration Date:
04/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
STOCK
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-833-5221

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  A19519 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A19510 . This is a "CLIA 05D0553631" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1700896909 . This is a "SOLE OWNER NPI" identifier . This identifiers is of the category "OTHER".




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