Healthcare Provider Details

I. General information

NPI: 1548366545
Provider Name (Legal Business Name): JENNIFER HARTSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E CHEVY CHASE DR SUITE 101
GLENDALE CA
91206-4163
US

IV. Provider business mailing address

1530 E CHEVY CHASE DR SUITE 101
GLENDALE CA
91206-4163
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-7260
  • Fax: 818-502-9247
Mailing address:
  • Phone: 818-246-7260
  • Fax: 818-502-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA75605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: