Healthcare Provider Details

I. General information

NPI: 1336189042
Provider Name (Legal Business Name): MARK STEVEN FOSTER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HIGHLAND SPRINGS AVENUE
BANNING CA
92220
US

IV. Provider business mailing address

2100 POWELL STREET STE 920
EMERYVILLE CA
94608-1803
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-1121
  • Fax:
Mailing address:
  • Phone: 510-350-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA61041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: