Provider Demographics
NPI:1972506483
Name:HOGAN, STEVEN G (NP)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:G
Last Name:HOGAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-1698
Mailing Address - Country:US
Mailing Address - Phone:619-806-1921
Mailing Address - Fax:858-552-4366
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-1698
Practice Address - Country:US
Practice Address - Phone:619-806-1921
Practice Address - Fax:858-552-4366
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2021-08-24
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-17
Provider Licenses
StateLicense IDTaxonomies
CANP14117363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ29352Medicare UPIN