Healthcare Provider Details

I. General information

NPI: 1801214317
Provider Name (Legal Business Name): ALEXANDRIA LILA STERN D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12265 VENTURA BLVD STE 107
STUDIO CITY CA
91604-2530
US

IV. Provider business mailing address

4234 MARY ELLEN AVE
STUDIO CITY CA
91604-1819
US

V. Phone/Fax

Practice location:
  • Phone: 310-691-5411
  • Fax:
Mailing address:
  • Phone: 818-207-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: