Healthcare Provider Details

I. General information

NPI: 1720187800
Provider Name (Legal Business Name): STEVEN LLOYD EPNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 VISTA WAY
OCEANSIDE CA
92056-4506
US

IV. Provider business mailing address

3156 VISTA WAY SUITE 100
OCEANSIDE CA
92056-3622
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-4055
  • Fax: 760-940-4084
Mailing address:
  • Phone: 760-547-8084
  • Fax: 760-547-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG78907
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG78907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: