Healthcare Provider Details

I. General information

NPI: 1023059615
Provider Name (Legal Business Name): MICHAEL BARRY STEINBERG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD BLDG 304, ROOM E3-123
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

10754 BARMAN AVE
CULVER CITY CA
90230-3737
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4723
Mailing address:
  • Phone: 310-204-2648
  • Fax: 310-268-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 12189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: