Provider Demographics
NPI:1114372356
Name:JULES STEIN INSTITUTE MEDICAL GROUP
Entity Type:Organization
Organization Name:JULES STEIN INSTITUTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONDINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-825-5053
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-254-9010
Mailing Address - Fax:262-254-9019
Practice Address - Street 1:5767 W CENTURY BLVD
Practice Address - Street 2:STE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5631
Practice Address - Country:US
Practice Address - Phone:310-301-8707
Practice Address - Fax:310-301-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies