MEDICARE: CARL STOCKLIN MS, AT

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1972448710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL STOCKLIN MS, AT

Provider Business Mailing Address
First Line	:	PO BOX 24044
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-0044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 CHARLES E YOUNG DRIVE WEST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-825-3965
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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