MEDICARE: DR. STACY J SCHLOCKER MD

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	207R00000X	Internal Medicine Physician	A93488	CA

General Provider Information

NPI Number	:	1548468598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY J SCHLOCKER MD

Provider Business Mailing Address
First Line	:	PO BOX 51066
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-5366
Country	:	US
Telephone Number	:	619-784-5888
Fax Number	:	858-784-5960

Provider Business Practice Location Address
First Line	:	501 WASHINGTON ST
Second Line	:	SUITE 600
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2239
Country	:	US
Telephone Number	:	619-278-3340
Fax Number	:	619-278-3310

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	03/28/2012

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