Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A70446 | CA |
Y | 213ES0000X | Sports Medicine | A70446 | CA |
NPI | 1467423046 |
---|---|
Provider Name | Dr. Steven Waltrip |
First Address | Beverly Hills, CA 90212-1842 |
Second Address | Beverly Hills, CA 90212-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 24/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H16765 | (02) | CA |