Provider Demographics
NPI:1447395348
Name:STERN, MIMI J (CMT)
Entity Type:Individual
Prefix:MS
First Name:MIMI
Middle Name:J
Last Name:STERN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 SARATOGA WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3437
Mailing Address - Country:US
Mailing Address - Phone:925-699-7377
Mailing Address - Fax:
Practice Address - Street 1:3711 SARATOGA WAY
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3437
Practice Address - Country:US
Practice Address - Phone:925-699-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist