MEDICARE: DR. STEVEN L BANKS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	20A6114	CA

General Provider Information

NPI Number	:	1306154851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN L BANKS D.O.

Provider Business Mailing Address
First Line	:	34101 FARENHOLT AVE BLDG 14
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-8251
Country	:	US
Telephone Number	:	619-532-7826
Fax Number	:	619-532-8251

Provider Business Practice Location Address
First Line	:	34101 FARENHOLT AVE BLDG 14
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-8251
Country	:	US
Telephone Number	:	619-532-7826
Fax Number	:	619-532-8251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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