Provider Demographics
NPI:1558797936
Name:STEIN, MICKEY DINER (MS)
Entity Type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:DINER
Last Name:STEIN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 THIRD STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124
Mailing Address - Country:US
Mailing Address - Phone:415-970-4000
Mailing Address - Fax:415-970-4016
Practice Address - Street 1:3801 THIRD STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124
Practice Address - Country:US
Practice Address - Phone:415-970-4000
Practice Address - Fax:415-970-4016
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2014-11-25
Deactivation Date:2014-07-24
Deactivation Code:
Reactivation Date:2014-11-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program