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NPI Code Detail

MEDICARE: STEVEN MICHAEL DETERVILLE MD

MEDICARE: STEVEN MICHAEL DETERVILLE 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
1208000000XPediatrics PhysicianA33195CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ31887ZOTHERCASITE LOCATION NUMBER

General Provider Information

NPI Number : 1700860285
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN MICHAEL DETERVILLE MD
Provider Business Mailing Address
First Line : 21634 RETREAT PKWY
Second Line :
City : CORONA
State : CA
Zip : 92883-6100
Country : US
Telephone Number : 951-493-6810
Fax Number : 951-826-8139
Provider Business Practice Location Address
First Line : 21634 RETREAT PKWY
Second Line :
City : CORONA
State : CA
Zip : 92883-6100
Country : US
Telephone Number : 951-493-6810
Fax Number : 951-826-8139
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 04/11/2025

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Directions to “ STEVEN MICHAEL DETERVILLE MD” Practice Location

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