Provider Demographics
NPI:1568429983
Name:HEIN, STACEY M (INTERNAL MEDICINE)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:HEIN
Suffix:
Gender:F
Credentials:INTERNAL MEDICINE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15215 NATIONAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-358-1841
Mailing Address - Fax:408-356-2151
Practice Address - Street 1:15215 NATIONAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2425
Practice Address - Country:US
Practice Address - Phone:408-358-1841
Practice Address - Fax:408-356-2151
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA770491483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73201Medicare UPIN
CA00A621840Medicare ID - Type Unspecified