Provider Demographics
NPI:1790803948
Name:RIS, STEVEN BERNARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BERNARD
Last Name:RIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 SANDPOINTE AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-8796
Mailing Address - Country:US
Mailing Address - Phone:714-546-0510
Mailing Address - Fax:
Practice Address - Street 1:201 SANDPOINTE AVE STE 135
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-8796
Practice Address - Country:US
Practice Address - Phone:714-546-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3858213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU42477Medicare UPIN