Healthcare Provider Details

I. General information

NPI: 1669088316
Provider Name (Legal Business Name): TATIANA STEVERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N RODEO DR # 1
BEVERLY HILLS CA
90210-4500
US

IV. Provider business mailing address

5850 W 3RD ST STE E1670
LOS ANGELES CA
90036-2881
US

V. Phone/Fax

Practice location:
  • Phone: 310-432-6640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: