Healthcare Provider Details

I. General information

NPI: 1861034753
Provider Name (Legal Business Name): STEVEN MICHAEL MCCREA ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE A107
LA JOLLA CA
92037-1708
US

IV. Provider business mailing address

2616 APERTURE CIR
SAN DIEGO CA
92108-2628
US

V. Phone/Fax

Practice location:
  • Phone: 858-254-5433
  • Fax:
Mailing address:
  • Phone: 619-606-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: