Provider Demographics
NPI:1740223338
Name:CORREA, STEVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVAN
Middle Name:
Last Name:CORREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 E. MAIN ST.
Mailing Address - Street 2:SUITE E243
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-407-5941
Mailing Address - Fax:
Practice Address - Street 1:2764 E. MAIN ST.
Practice Address - Street 2:SUITE E243
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-407-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71101207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A711010Medicaid
CAWA71101Medicare ID - Type Unspecified
CAH44423Medicare UPIN
CA00A711010Medicaid