Provider Demographics
NPI:1851867105
Name:KURUMADA, STEVEN (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KURUMADA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 TREASURE CAY DR APT 305
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-5364
Mailing Address - Country:US
Mailing Address - Phone:949-648-6596
Mailing Address - Fax:
Practice Address - Street 1:5101 OKEECHOBEE RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-5415
Practice Address - Country:US
Practice Address - Phone:949-648-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant