Healthcare Provider Details

I. General information

NPI: 1750450763
Provider Name (Legal Business Name): NICOLE STEG P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S VAL VISTA DR STE A3-620
GILBERT AZ
85296-0942
US

IV. Provider business mailing address

2100 POWELL ST STE 900
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 480-347-4648
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3539
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: