Healthcare Provider Details

I. General information

NPI: 1629367230
Provider Name (Legal Business Name): NATHANIEL DAVID STEIN MT-BC, NMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 S WILLARD AVE
SAN JOSE CA
95126-3371
US

IV. Provider business mailing address

473 S WILLARD AVE
SAN JOSE CA
95126-3371
US

V. Phone/Fax

Practice location:
  • Phone: 408-768-6668
  • Fax:
Mailing address:
  • Phone: 408-768-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09536
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: