Healthcare Provider Details

I. General information

NPI: 1417090648
Provider Name (Legal Business Name): STEVE A. EKLUND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

IV. Provider business mailing address

303 E VANDERBILT WAY
SAN BERNARDINO CA
92415-0026
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-8300
  • Fax: 760-955-2356
Mailing address:
  • Phone: 909-388-0878
  • Fax: 909-890-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA72281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: