Provider Demographics
NPI:1093994170
Name:WORTMAN, STEVEN BRIAN (CST)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:BRIAN
Last Name:WORTMAN
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 E CALVADA BLVD
Mailing Address - Street 2:300
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-3905
Mailing Address - Country:US
Mailing Address - Phone:775-727-1555
Mailing Address - Fax:775-727-1557
Practice Address - Street 1:1470 E CALVADA BLVD
Practice Address - Street 2:300
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-3905
Practice Address - Country:US
Practice Address - Phone:775-727-1555
Practice Address - Fax:775-727-1557
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
CO95464246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist