Provider Demographics
NPI:1104964303
Name:MA, STEVEN ST (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ST
Last Name:MA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2110
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2110
Mailing Address - Country:US
Mailing Address - Phone:626-350-6776
Mailing Address - Fax:626-350-3353
Practice Address - Street 1:9428 VALLEY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1570
Practice Address - Country:US
Practice Address - Phone:626-350-6776
Practice Address - Fax:626-350-3353
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ053ZMedicare PIN
CAW15680AMedicare PIN