Provider Demographics
NPI:1548468598
Name:SCHLOCKER, STACY J (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:J
Last Name:SCHLOCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51066
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5366
Mailing Address - Country:US
Mailing Address - Phone:619-784-5888
Mailing Address - Fax:858-784-5960
Practice Address - Street 1:501 WASHINGTON ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2239
Practice Address - Country:US
Practice Address - Phone:619-278-3340
Practice Address - Fax:619-278-3310
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine