Provider Demographics
NPI:1629012778
Name:EBERSTEIN, STEPHANIE RUDIN
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RUDIN
Last Name:EBERSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE # 55745
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:818-343-8116
Mailing Address - Fax:818-343-7170
Practice Address - Street 1:3525 PACIFIC COAST HWY
Practice Address - Street 2:SUITE N
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6655
Practice Address - Country:US
Practice Address - Phone:310-534-1113
Practice Address - Fax:310-534-3850
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 715231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist