Healthcare Provider Details

I. General information

NPI: 1780159749
Provider Name (Legal Business Name): STEIN DERMATOLOGY A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 4TH AVE STE 14
CHULA VISTA CA
91910-3813
US

IV. Provider business mailing address

340 4TH AVE STE 14
CHULA VISTA CA
91910-3813
US

V. Phone/Fax

Practice location:
  • Phone: 619-303-3681
  • Fax: 619-831-8252
Mailing address:
  • Phone: 619-303-3681
  • Fax: 619-831-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER DORU STEIN
Title or Position: CEO
Credential: MD
Phone: 619-303-3681