Provider Demographics
NPI:1770771727
Name:STEFFEN, SCOTT P (AA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:P
Last Name:STEFFEN
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2530
Mailing Address - Country:US
Mailing Address - Phone:209-238-9436
Mailing Address - Fax:209-569-0676
Practice Address - Street 1:800 SCENIC DR
Practice Address - Street 2:NORTH END BUILDING #4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-238-9436
Practice Address - Fax:209-569-0676
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator