Healthcare Provider Details

I. General information

NPI: 1467998096
Provider Name (Legal Business Name): MR. STEVEN SCOTT TONNESEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ANGELICA WAY
MORGAN HILL CA
95037-2723
US

IV. Provider business mailing address

30 ANGELICA WAY
MORGAN HILL CA
95037
US

V. Phone/Fax

Practice location:
  • Phone: 669-262-7466
  • Fax:
Mailing address:
  • Phone: 669-262-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberF8342620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberF8342620
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberF8342620
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License NumberF8342620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: