Healthcare Provider Details

I. General information

NPI: 1588999635
Provider Name (Legal Business Name): STEVEN M. BACK MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER
LOS ANGELES CA
90045-1543
US

IV. Provider business mailing address

PO BOX 4148
TORRANCE CA
90510-4148
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7150
  • Fax: 310-665-7171
Mailing address:
  • Phone: 310-792-3914
  • Fax: 310-792-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA78879
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN M BACK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-403-1780