Healthcare Provider Details

I. General information

NPI: 1013141845
Provider Name (Legal Business Name): STONE TOUTRIA LOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 BUTTONWILLOW AVE
STOCKTON CA
95207-1353
US

IV. Provider business mailing address

2521 BUTTONWILLOW AVE
STOCKTON CA
95207-1353
US

V. Phone/Fax

Practice location:
  • Phone: 209-373-0235
  • Fax:
Mailing address:
  • Phone: 209-373-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number10-00100634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: