Healthcare Provider Details

I. General information

NPI: 1336324011
Provider Name (Legal Business Name): GERALD S. STEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JERRY STEIN M.D.

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

IV. Provider business mailing address

645 COUNTY ROAD 235
EUREKA SPRINGS AR
72632-9284
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberE-6288
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number22923
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number2012013495
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG19707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: