Provider Demographics
NPI:1952457624
Name:LECORNO, STANLEY LOUIE (PHD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:LOUIE
Last Name:LECORNO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:STANLEY
Other - Middle Name:LOUIE
Other - Last Name:LECORNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-0762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N HUMBOLDT AVE APT 265
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-3534
Practice Address - Country:US
Practice Address - Phone:530-934-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA015545343900000X, 344600000X, 347E00000X
015545347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA015545OtherPUC