Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E29050 | CA |
Y | 222Z00000X | Podiatrist | E29050 | CA |
NPI | 1073532040 |
---|---|
Provider Name | Michael A Stein |
First Address | San Leandro, CA 94577-5147 |
Second Address | San Leandro, CA 94577-5147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 09/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E29051 | (05) | CA |
T11514 | (02) | CA |