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General NPI Number Information
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NPI Number | 1376623215
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Entity Type | Individual
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Provider Name | DEBRA M STOCK PA
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 480 CHADBOURNE RD
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City | FAIRFIELD
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State | CA
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Zip | 94534-9639
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Country | US
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Telephone | 707-399-4500
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Fax | 707-399-9419
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Provider Business Mailing Address
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Address Line | 2290 SACRAMENTO ST
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City | VALLEJO
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State | CA
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Zip | 94590-2929
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Country | US
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Telephone | 707-643-5785
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Fax | 707-643-5876
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA16490
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License Number State | CA
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