Provider Demographics
NPI:1609633296
Name:STEVEN, BRET M
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:M
Last Name:STEVEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79220 VIOLET CT
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4253
Mailing Address - Country:US
Mailing Address - Phone:760-619-8795
Mailing Address - Fax:
Practice Address - Street 1:79220 VIOLET CT
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4253
Practice Address - Country:US
Practice Address - Phone:760-619-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52581208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation