Provider Demographics
NPI:1790832111
Name:DRELL, STEVEN ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLEN
Last Name:DRELL
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 1:13320 RIVERSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2502
Mailing Address - Country:US
Mailing Address - Phone:818-784-9905
Mailing Address - Fax:818-784-0135
Practice Address - Street 1:13320 RIVERSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2502
Practice Address - Country:US
Practice Address - Phone:818-784-9905
Practice Address - Fax:818-784-0135
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG35439DMedicare ID - Type UnspecifiedLEGACY NUMBER
CAE95995Medicare UPIN