Healthcare Provider Details

I. General information

NPI: 1366572588
Provider Name (Legal Business Name): BARBARA STERN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24255 PACIFIC COAST HWY
MALIBU CA
90263-3999
US

IV. Provider business mailing address

6625 SMOKE TREE AVE
OAK PARK CA
91377-1303
US

V. Phone/Fax

Practice location:
  • Phone: 310-506-4316
  • Fax: 310-506-4588
Mailing address:
  • Phone: 818-889-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number179062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: