Healthcare Provider Details

I. General information

NPI: 1972448710
Provider Name (Legal Business Name): CARL STOCKLIN MS, AT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CHARLES E YOUNG DRIVE WEST
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

PO BOX 24044
LOS ANGELES CA
90024-0044
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-3965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: