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NPI Code Detail

MEDICARE: DEBRA M STOCK PA

MEDICARE: DEBRA M STOCK PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant
2363A00000XPhysician AssistantPA16490CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376623215
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA M STOCK PA
Provider Business Mailing Address
First Line : 2290 SACRAMENTO ST
Second Line :
City : VALLEJO
State : CA
Zip : 94590-2929
Country : US
Telephone Number : 707-643-5785
Fax Number : 707-643-5876
Provider Business Practice Location Address
First Line : 480 CHADBOURNE RD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94534-9639
Country : US
Telephone Number : 707-399-4500
Fax Number : 707-399-9419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 05/10/2023

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