Provider Demographics
NPI:1326182460
Name:RACZEK, STANLEY
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:RACZEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5089 MANOR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2895
Mailing Address - Country:US
Mailing Address - Phone:760-725-1555
Mailing Address - Fax:760-725-1267
Practice Address - Street 1:BLDG H-100 SANTA MARGARITA ROAD
Practice Address - Street 2:NAVAL HOSPITAL
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-8882
Practice Address - Fax:760-725-1267
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1430762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry