Provider Demographics
NPI:1457677874
Name:STANLEY L. STOCK, M. D., INC.
Entity Type:Organization
Organization Name:STANLEY L. STOCK, M. D., INC.
Other - Org Name:STANLEY L. STOCK, M. D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:310-833-5221
Mailing Address - Street 1:1428 W 7TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3523
Mailing Address - Country:US
Mailing Address - Phone:310-833-5221
Mailing Address - Fax:310-833-4022
Practice Address - Street 1:1428 W 7TH ST STE B
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3523
Practice Address - Country:US
Practice Address - Phone:310-833-5221
Practice Address - Fax:310-833-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19519261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
A19510OtherCLIA 05D0553631
1700896909OtherSOLE OWNER NPI
CAA21779Medicare UPIN