Healthcare Provider Details

I. General information

NPI: 1205918422
Provider Name (Legal Business Name): STEVEN ANTHONY PAVKOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/05/2020
Certification Date: 09/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

PO BOX 1449
BREA CA
92822-1449
US

V. Phone/Fax

Practice location:
  • Phone: 626-460-1796
  • Fax: 714-996-9267
Mailing address:
  • Phone: 714-996-1633
  • Fax: 714-996-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG74968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: