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General NPI Number Information
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NPI Number | 1700860285
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Entity Type | Individual
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Provider Name | STEVEN MICHAEL DETERVILLE MD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 21634 RETREAT PKWY
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City | CORONA
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State | CA
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Zip | 92883-6100
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Country | US
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Telephone | 951-493-6810
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Fax | 951-826-8139
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Provider Business Mailing Address
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Address Line | 21634 RETREAT PKWY
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City | CORONA
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State | CA
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Zip | 92883-6100
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Country | US
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Telephone | 951-493-6810
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Fax | 951-826-8139
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A33195
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License Number State | CA
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