1962610279 NPI number — DR. DUSTIN ERIN STEVENSON D.O.

Table of content: DR. DUSTIN ERIN STEVENSON D.O. (NPI 1962610279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962610279 NPI number — DR. DUSTIN ERIN STEVENSON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENSON
Provider First Name:
DUSTIN
Provider Middle Name:
ERIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962610279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E CHURCH ST
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-739-3114
Provider Business Mailing Address Fax Number:
805-739-3060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 E CHURCH ST STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-5915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-349-9393
Provider Business Practice Location Address Fax Number:
805-349-1155
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  20A12043 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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