Provider Demographics
NPI:1003171851
Name:DILLAVOU, STEVEN K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:K
Last Name:DILLAVOU
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2020 SANTA MONICA BLVD
Mailing Address - Street 2:FL 3
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2023
Mailing Address - Country:US
Mailing Address - Phone:310-582-7313
Mailing Address - Fax:
Practice Address - Street 1:5215 TORRANCE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4009
Practice Address - Country:US
Practice Address - Phone:424-212-5361
Practice Address - Fax:310-316-3466
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2021-03-31
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Provider Licenses
StateLicense IDTaxonomies
NH1301363A00000X
FL9108537363A00000X
IA002305363A00000X
CA54486363A00000X
CO0004506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant