Healthcare Provider Details

I. General information

NPI: 1063694297
Provider Name (Legal Business Name): STEVEN NALTSAS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 BALBOA BLVD STE 250
GRANADA HILLS CA
91344-6361
US

IV. Provider business mailing address

10515 BALBOA BLVD STE 250
GRANADA HILLS CA
91344-6361
US

V. Phone/Fax

Practice location:
  • Phone: 818-368-5175
  • Fax: 818-368-5111
Mailing address:
  • Phone: 818-368-5175
  • Fax: 818-368-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC37351
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN NALTSAS
Title or Position: OWNER
Credential: MD
Phone: 818-368-5175