Provider Demographics
NPI:1639244288
Name:KLOMPUS, STEVEN JEROME (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JEROME
Last Name:KLOMPUS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:81767 DR CARREON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5599
Mailing Address - Country:US
Mailing Address - Phone:760-775-4181
Mailing Address - Fax:760-775-4818
Practice Address - Street 1:74990 COUNTRY CLUB DR STE 310
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1991
Practice Address - Country:US
Practice Address - Phone:760-341-8800
Practice Address - Fax:760-775-4818
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10007363A00000X
CA10007363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639244288OtherNPI