Healthcare Provider Details

I. General information

NPI: 1821069535
Provider Name (Legal Business Name): ANDREW JAMES STEIN M D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13690 E 14TH ST SUITE # 200
SAN LEANDRO CA
94578-2582
US

IV. Provider business mailing address

13690 E 14TH ST SUITE # 200
SAN LEANDRO CA
94578-2582
US

V. Phone/Fax

Practice location:
  • Phone: 510-297-0550
  • Fax: 510-297-0558
Mailing address:
  • Phone: 510-297-0550
  • Fax: 510-297-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG75352
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 2258
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 2257
License Number StateCA

VIII. Authorized Official

Name: MRS. BRENDA D COBB
Title or Position: OFFICE SUPERVISOR/BILLER
Credential:
Phone: 510-297-0550