Provider Demographics
NPI:1710005202
Name:IREY, STEVEN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:IREY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES, 2ND FLOOR
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:SUITE 301
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2449
Practice Address - Country:US
Practice Address - Phone:530-242-3500
Practice Address - Fax:530-242-3546
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11581363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical