1821577966 NPI number — MRS. ELLEN HANES STEIN I OT

Table of content: MRS. ELLEN HANES STEIN I OT (NPI 1821577966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821577966 NPI number — MRS. ELLEN HANES STEIN I OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIN
Provider First Name:
ELLEN
Provider Middle Name:
HANES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
I
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821577966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 APPLEGATE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94502-7714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-865-3241
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21966 DOLORES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTRO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94546-6900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-733-2413
Provider Business Practice Location Address Fax Number:
510-583-1263
Provider Enumeration Date:
08/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT164 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043489016 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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