Provider Demographics
NPI:1508141359
Name:WEINSTEIN, STACEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RONALD REAGAN UCLA MEDICAL CTR
Mailing Address - Street 2:757 WESTWOOD PLAZA, SUITE 7501
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7417
Mailing Address - Country:US
Mailing Address - Phone:310-267-9648
Mailing Address - Fax:310-267-3595
Practice Address - Street 1:RONALD REAGAN UCLA MEDICAL CTR
Practice Address - Street 2:757 WESTWOOD PLAZA, SUITE 7501
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7417
Practice Address - Country:US
Practice Address - Phone:310-267-9648
Practice Address - Fax:310-267-3595
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA121633207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics