Healthcare Provider Details

I. General information

NPI: 1346805975
Provider Name (Legal Business Name): GEORGIA STEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 GREEN VALLEY RD
WATSONVILLE CA
95076-1300
US

IV. Provider business mailing address

5 LOMA AVE
WATSONVILLE CA
95076-1618
US

V. Phone/Fax

Practice location:
  • Phone: 831-786-2100
  • Fax:
Mailing address:
  • Phone: 916-517-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: