Provider Demographics
NPI:1831831031
Name:STEIN, MIRANDA CAMILLE (MD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CAMILLE
Last Name:STEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:CAMILLE
Other - Last Name:LYBYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31001-4114
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-4114
Mailing Address - Country:US
Mailing Address - Phone:667-478-2455
Mailing Address - Fax:509-944-9644
Practice Address - Street 1:1919 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2347
Practice Address - Country:US
Practice Address - Phone:509-747-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351049720208000000X
WAMD61685080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics