Healthcare Provider Details

I. General information

NPI: 1720714900
Provider Name (Legal Business Name): ALEXANDRA MYRAH STEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

9313 BURTON WAY APT A
BEVERLY HILLS CA
90210-3654
US

V. Phone/Fax

Practice location:
  • Phone: 424-877-6226
  • Fax:
Mailing address:
  • Phone: 424-877-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2022-1184
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: