Provider Demographics
NPI:1396876926
Name:STEINER, JERROLD HAL (MD)
Entity type:Individual
Prefix:
First Name:JERROLD
Middle Name:HAL
Last Name:STEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1810
Mailing Address - Country:US
Mailing Address - Phone:310-423-9331
Mailing Address - Fax:310-423-9399
Practice Address - Street 1:310 N SAN VICENTE BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1810
Practice Address - Country:US
Practice Address - Phone:310-423-9331
Practice Address - Fax:310-423-9399
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13649208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG13649AMedicare PIN
A39050Medicare UPIN