MEDICARE: RACHEL LORENE STOCKTON

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
1	1041C0700X	Clinical Social Worker	27948	CA

General Provider Information

NPI Number	:	1497106686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LORENE STOCKTON

Provider Business Mailing Address
First Line	:	2902 EDELL PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-1618
Country	:	US
Telephone Number	:	858-395-0568
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 5TH AVE
Second Line	:	SUITE 214
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2139
Country	:	US
Telephone Number	:	858-395-0568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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