Healthcare Provider Details

I. General information

NPI: 1265558266
Provider Name (Legal Business Name): STEVEN ANDREW BRODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8899 UNIVERSITY CENTER LN SUITE 100
SAN DIEGO CA
92122-1013
US

IV. Provider business mailing address

7514 GIRARD AVE SUITE 201
LA JOLLA CA
92037-5149
US

V. Phone/Fax

Practice location:
  • Phone: 619-265-1800
  • Fax: 858-453-8587
Mailing address:
  • Phone: 619-265-1800
  • Fax: 858-453-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG47356
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG47356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: