Basic Information
| Provider Information | |||||||||
| NPI: | 1114372356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JULES STEIN INSTITUTE MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 W DUARTE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910077606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262549010 | ||||||||
| FaxNumber: | 2622549019 | ||||||||
| Practice Location | |||||||||
| Address1: | 5767 W CENTURY BLVD | ||||||||
| Address2: | STE 400 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103018707 | ||||||||
| FaxNumber: | 3103018751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2016 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | MONDINO | ||||||||
| AuthorizedOfficialFirstName: | BARTLY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 3108255053 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.