Healthcare Provider Details

I. General information

NPI: 1679641385
Provider Name (Legal Business Name): MARTIN T STEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST SUITE 350
SAN DIEGO CA
92123-2771
US

IV. Provider business mailing address

9500 GILMAN DRIVE MC 8464
LA JOLLA CA
92093-8464
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-4800
  • Fax: 858-496-4850
Mailing address:
  • Phone: 619-657-8340
  • Fax: 619-543-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA23490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: