Provider Demographics
NPI:1902015498
Name:STEPHEN R STEELE DO INC
Entity Type:Organization
Organization Name:STEPHEN R STEELE DO INC
Other - Org Name:ADVANTAGE SPORTS AND WELLNESS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-360-1433
Mailing Address - Street 1:78120 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-1140
Mailing Address - Country:US
Mailing Address - Phone:760-360-1433
Mailing Address - Fax:760-360-5092
Practice Address - Street 1:78120 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-1140
Practice Address - Country:US
Practice Address - Phone:760-360-1433
Practice Address - Fax:760-360-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A555207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285632604OtherTYPE 1 NPI NUMBER
CA20A555OtherLICENSE
1285632604OtherTYPE 1 NPI NUMBER
CA20A555OtherLICENSE