Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G88354 | CA |
NPI | 1003060492 |
---|---|
Provider Name | Dr. Seth R Stevens |
First Address | Thousand Oaks, CA 91360-4211 |
Second Address | Thousand Oaks, CA 91360-4211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C91203 | (02) |