=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285632604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN ROSS STEELE D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2005
-----------------------------------------------------
Last Update Date | 03/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45280 SEELEY DR
-----------------------------------------------------
City | LA QUINTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92253-6834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-610-7300
-----------------------------------------------------
Fax | 760-610-7301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45280 SEELEY DR
-----------------------------------------------------
City | LA QUINTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92253-6834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-610-7300
-----------------------------------------------------
Fax | 760-610-7301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 20A5555
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5555
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------