Healthcare Provider Details

I. General information

NPI: 1700860285
Provider Name (Legal Business Name): STEVEN MICHAEL DETERVILLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21634 RETREAT PKWY
CORONA CA
92883-6100
US

IV. Provider business mailing address

21634 RETREAT PKWY
CORONA CA
92883-6100
US

V. Phone/Fax

Practice location:
  • Phone: 951-493-6810
  • Fax: 951-826-8139
Mailing address:
  • Phone: 951-493-6810
  • Fax: 951-826-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA33195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: