Provider Demographics
NPI:1861682593
Name:STEVEN CALLEROS MD INC.
Entity Type:Organization
Organization Name:STEVEN CALLEROS MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-314-8300
Mailing Address - Street 1:4499 VIA MARISOL APT 107A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5129
Mailing Address - Country:US
Mailing Address - Phone:818-314-8300
Mailing Address - Fax:
Practice Address - Street 1:4499 VIA MARISOL APT 107A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-5129
Practice Address - Country:US
Practice Address - Phone:818-314-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73924302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization