Provider Demographics
NPI:1013196021
Name:DESTEFANO, STEVEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:DESTEFANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 W TEMPLE AVE
Mailing Address - Street 2:46
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2557
Mailing Address - Country:US
Mailing Address - Phone:909-869-4000
Mailing Address - Fax:909-869-4561
Practice Address - Street 1:3801 W TEMPLE AVE
Practice Address - Street 2:46
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2557
Practice Address - Country:US
Practice Address - Phone:909-869-4000
Practice Address - Fax:909-869-4561
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine