Healthcare Provider Details

I. General information

NPI: 1497050819
Provider Name (Legal Business Name): AMANDA EMILY STEIN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11031 OHIO AVE
LOS ANGELES CA
90025-3432
US

IV. Provider business mailing address

11031 OHIO AVE
LOS ANGELES CA
90025-3432
US

V. Phone/Fax

Practice location:
  • Phone: 310-776-0452
  • Fax: 424-248-3450
Mailing address:
  • Phone: 310-776-0452
  • Fax: 424-248-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number833707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: