Healthcare Provider Details

I. General information

NPI: 1467423046
Provider Name (Legal Business Name): STEVEN WALTRIP M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE# 400
BEVERLY HILLS CA
90212-1842
US

IV. Provider business mailing address

120 S SPALDING DR STE# 400
BEVERLY HILLS CA
90212-1842
US

V. Phone/Fax

Practice location:
  • Phone: 310-860-3434
  • Fax:
Mailing address:
  • Phone: 310-860-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA70446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: