Provider Demographics
NPI:1497050819
Name:STEIN, AMANDA EMILY (RD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:EMILY
Last Name:STEIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3432
Mailing Address - Country:US
Mailing Address - Phone:310-776-0452
Mailing Address - Fax:424-248-3450
Practice Address - Street 1:11031 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3432
Practice Address - Country:US
Practice Address - Phone:310-776-0452
Practice Address - Fax:424-248-3450
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA833707133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic