Provider Demographics
NPI:1164656914
Name:EA, STEVEN (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:EA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13847 E 14TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2626
Mailing Address - Country:US
Mailing Address - Phone:510-483-3390
Mailing Address - Fax:510-394-6402
Practice Address - Street 1:1300 BANCROFT AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5147
Practice Address - Country:US
Practice Address - Phone:510-483-3390
Practice Address - Fax:510-394-6402
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2023-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY6508213ES0103X
CAE5502213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery