Provider Demographics
NPI:1659708121
Name:PILLON, STEVE MARK
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:MARK
Last Name:PILLON
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 1:2010 LINCOLN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3119
Mailing Address - Country:US
Mailing Address - Phone:323-222-1440
Mailing Address - Fax:
Practice Address - Street 1:2010 LINCOLN PARK AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3119
Practice Address - Country:US
Practice Address - Phone:323-222-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112570171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator