Healthcare Provider Details

I. General information

NPI: 1104528900
Provider Name (Legal Business Name): STEPHEN MOCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SAND CREEK RD
ANTIOCH CA
94531-8687
US

IV. Provider business mailing address

4501 SAND CREEK RD
ANTIOCH CA
94531-8687
US

V. Phone/Fax

Practice location:
  • Phone: 925-813-6500
  • Fax:
Mailing address:
  • Phone: 925-813-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: