Healthcare Provider Details

I. General information

NPI: 1760431654
Provider Name (Legal Business Name): ALEXANDER DORU STEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 FOURTH AVE STE 14
CHULA VISTA CA
91910
US

IV. Provider business mailing address

340 FOURTH AVE STE 14
CHULA VISTA CA
91910-3813
US

V. Phone/Fax

Practice location:
  • Phone: 718-753-6536
  • Fax: 619-258-0028
Mailing address:
  • Phone: 619-303-3681
  • Fax: 619-258-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD036056
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA106295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: