Healthcare Provider Details

I. General information

NPI: 1528389897
Provider Name (Legal Business Name): MR. STEVE CREAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12424 WILSHIRE BLVD
LOS ANGELES CA
90025-1052
US

IV. Provider business mailing address

12424 WILSHIRE BLVD
LOS ANGELES CA
90025-1052
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-2977
  • Fax: 310-826-5687
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number6014
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6014
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: