Provider Demographics
NPI:1508849860
Name:DEGALAN, STEVEN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRUCE
Last Name:DEGALAN
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 1:39231 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1501
Mailing Address - Country:US
Mailing Address - Phone:510-795-1700
Mailing Address - Fax:510-887-3069
Practice Address - Street 1:39231 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1501
Practice Address - Country:US
Practice Address - Phone:510-795-1700
Practice Address - Fax:510-887-3069
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53602207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G536021Medicaid
CAA52554Medicare UPIN
CA00G536020Medicare ID - Type Unspecified