Basic Information
| Provider Information | |||||||||
| NPI: | 1376539981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STERNBERG | ||||||||
| FirstName: | HARVEY | ||||||||
| MiddleName: | JOEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 339 | ||||||||
| Address2: | |||||||||
| City: | MOUNT SHASTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960670339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5309265613 | ||||||||
| FaxNumber: | 5309268798 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 ALAMO AVE | ||||||||
| Address2: | |||||||||
| City: | WEED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960942352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5309383491 | ||||||||
| FaxNumber: | 5309382662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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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 | 207Q00000X | G52017 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080076462 | 01 | RAILROAD MEDICARE | OTHER | 00G520170 | 05 | CA | MEDICAID |