Provider Demographics
NPI:1619067790
Name:COLBY, STEVE M (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:M
Last Name:COLBY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28325 STANSFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1999
Mailing Address - Country:US
Mailing Address - Phone:661-993-9190
Mailing Address - Fax:
Practice Address - Street 1:24510 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1337
Practice Address - Country:US
Practice Address - Phone:661-260-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA1125163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00NA11250Medicaid
CANA1125Medicare ID - Type Unspecified
CA00NA11250Medicaid