Provider Demographics
NPI:1013141845
Name:LOR, STONE TOUTRIA
Entity type:Individual
Prefix:
First Name:STONE
Middle Name:TOUTRIA
Last Name:LOR
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 1:2521 BUTTONWILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-1353
Mailing Address - Country:US
Mailing Address - Phone:209-373-0235
Mailing Address - Fax:
Practice Address - Street 1:2521 BUTTONWILLOW AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-1353
Practice Address - Country:US
Practice Address - Phone:209-373-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10-00100634172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver