Healthcare Provider Details

I. General information

NPI: 1407915150
Provider Name (Legal Business Name): STEVEN A. VASILEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

18075 VENTURA BLVD STE 108
ENCINO CA
91316-3599
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8402
  • Fax: 310-829-8914
Mailing address:
  • Phone: 310-739-1127
  • Fax: 888-234-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG56061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: