Healthcare Provider Details

I. General information

NPI: 1831831031
Provider Name (Legal Business Name): MIRANDA CAMILLE STEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA CAMILLE LYBYER

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S GRAND BLVD
SPOKANE WA
99203-2347
US

IV. Provider business mailing address

PO BOX 31001-4114
PASADENA CA
91110-4114
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-3081
  • Fax:
Mailing address:
  • Phone: 667-478-2455
  • Fax: 509-944-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351049720
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61685080
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: