Provider Demographics
NPI:1619907284
Name:VINES, STEVEN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:VINES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:M
Other - Last Name:VINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:451 W GONZALES RD
Mailing Address - Street 2:STE 260
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-9004
Mailing Address - Country:US
Mailing Address - Phone:805-485-3151
Mailing Address - Fax:805-983-8013
Practice Address - Street 1:133 W SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2543
Practice Address - Country:US
Practice Address - Phone:805-641-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2291213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619907284OtherNPI
CA000E22910Medicaid
CA4247000001Medicare NSC
CA000E22910Medicaid
CA1619907284OtherNPI