Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5555 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | 20A5555 | CA |
NPI | 1285632604 |
---|---|
Provider Name | Dr. Stephen Ross Steele |
First Address | La Quinta, CA 92253-6834 |
Second Address | La Quinta, CA 92253-6834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 01/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205071093 | TAX ID (01) | CA |
20A5555 | STATE LICENSE (01) | CA |
F22713 | (02) | CA |