MEDICARE: ERIC W STEVENS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A142435	CA

General Provider Information

NPI Number	:	1215314430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC W STEVENS MD

Provider Business Mailing Address
First Line	:	5341 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4078
Country	:	US
Telephone Number	:	714-477-8490
Fax Number	:

Provider Business Practice Location Address
First Line	:	5341 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4078
Country	:	US
Telephone Number	:	714-477-8490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	12/12/2018

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