Basic Information
| Provider Information | |||||||||
| NPI: | 1932152220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILVERSTEIN | ||||||||
| FirstName: | ALLAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 9TH ST | ||||||||
| Address2: | 4 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904022849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103939506 | ||||||||
| FaxNumber: | 3103939506 | ||||||||
| Practice Location | |||||||||
| Address1: | 1533 EUCLID ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904043306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104519747 | ||||||||
| FaxNumber: | 3103939506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF73623 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00G258900 | 05 | CA | MEDICAID | AS9688031 | 01 | CA | DEA NUMBER | OTHER |