Provider Demographics
NPI:1912186495
Name:STEVEN P. STILES, M.D., A MEDICAL CORP.
Entity Type:Organization
Organization Name:STEVEN P. STILES, M.D., A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-996-3400
Mailing Address - Street 1:18370 BURBANK BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2804
Mailing Address - Country:US
Mailing Address - Phone:818-996-3400
Mailing Address - Fax:818-996-8643
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-996-3400
Practice Address - Fax:818-996-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14053207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG14053OtherCA MEDICAL LICENSE
CA00G140530Medicaid
CAG14053OtherCA MEDICAL LICENSE
CA00G140530Medicaid
CAW14064Medicare PIN