Provider Demographics
NPI:1710986328
Name:STOCKFORD, LISA C (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:STOCKFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3254
Mailing Address - Country:US
Mailing Address - Phone:909-219-9804
Mailing Address - Fax:909-219-9806
Practice Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 110
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3254
Practice Address - Country:US
Practice Address - Phone:909-219-9804
Practice Address - Fax:909-219-9806
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A79250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A79250OtherBLUE SHIELD
CA00AX79250Medicaid
CAP00092811OtherRAIL ROAD MEDICARE
CA020A79250Medicare ID - Type Unspecified
CA00AX79250Medicaid