KENNETH STEVENS (NPI# 1184643629) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184643629 |
| Entity Type | Individual |
| Full Name | KENNETH STEVENS |
| Credential | M.D. |
| Practice Address |
3231 S Higuera St San Luis Obispo CA 93401-6924 |
| Practice Telephone | 8055403333 |
| Practice Fax Number | 8055403344 |
| Mailing Telephone | 8055403333 |
| Mailing Fax Number | 8055403344 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-04-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
A102905 | CA | Allopathic & Osteopathic Physicians |
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
A102905 | CA | Allopathic & Osteopathic Physicians |
| N | 202K00000X | Phlebology | A102905 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD PROVIDER NUMBER | 0A1029050 | 01 |
| CA | AETNA PROVIDER NUMBER | 9136184 | 01 |
| CA | MEDICAL BOARD LICENSE | A102905 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053854687 | Kenneth Stevens | Counselor | 102 W Main St, San Jacinto, CA 92583-4121 | 2016-11-30 |
| 1134569882 | Kenneth R Stevens IIi | Internal Medicine | 4077 Fifth Ave # Mer35, San Diego, CA 92103 | 2013-06-26 |
| 1033303847 | Kenneth Richards Stevens Jr. | Radiology | 3181 Sw Sam Jackson Park Rd., Kpv4, Radiation Medicine, Portland, OR 97239-3098 | 2007-09-05 |
| 1114131315 | Kenneth Troy Stevens | Dentist | 815 N 6th E, Mountain Home, ID 83647-2207 | 2007-05-09 |
| 1184607087 | Kenneth A Stevens | Internal Medicine | 26 Julio Dr, Shrewsbury, MA 01545-3020 | 2005-11-23 |
| Street Address |
3231 S HIGUERA ST |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93401-6924 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720391527 | Premier Vein Care | Phlebology | 3231 S Higuera St, San Luis Obispo, CA 93401-6924 | 2010-07-21 |
| 1265606081 | Kenneth Stevens Md Inc A Medical Corporation | Internal Medicine | 3231 S Higuera St, San Luis Obispo, CA 93401-6924 | 2008-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497228399 | Barbara Jean Morrow | Dental Hygienist | 2191 Johnson Avenue, San Luis Obispo, CA 93401 | 2019-01-03 |
| 1104307743 | Griffith Jennings | Counselor | 1225 Kendal Rd, San Luis Obispo, CA 93401 | 2018-08-22 |
| 1124518808 | Joy L Delaluna | Licensed Psychiatric Technician | 692 Evens Rd, San Luis Obispo, CA 93401 | 2018-05-17 |
| 1982192084 | Sierra Mental Wellness Group | Community/Behavioral Health | 2180 B Johnson Avenue, San Luis Obispo, CA 93401 | 2018-04-25 |
| 1326554403 | Veronica Chanel Laguna | Case Manager/Care Coordinator | 1065 Kansas Ave., San Luis Obispo, CA 93401 | 2017-12-27 |
| 1043739782 | Janette Lynn Branca | Case Manager/Care Coordinator | 285 South Street, Suit J, San Louis Obispo, CA 93401 | 2017-09-13 |
| 1588194104 | Adv Vision LLC | Optometrist | 835 Aero Vista Pl, #110, San Luis Obispo, CA 93401 | 2017-06-15 |
| 1508395880 | Samantha Clay | Counselor | 1255 Kendall Road, San Luis Obispo, CA 93401 | 2017-06-08 |
| 1659804771 | Sara Anne Powers | Counselor | 697 Higuera Street D, San Luis Obispo, CA 93401 | 2017-04-05 |
| 1508306010 | Russell Piazza | Pharmacist | 873 Ricardo Court, San Luis Obispo, CA 93401 | 2017-03-02 |
| Find all providers in zip 93401 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962664888 | Coastal Cardiology A Medical Corp | Internal Medicine | 1941 Johnson Ave Ste 102, San Luis Obispo, CA 93401-4154 | 2008-07-01 |
| 1508960527 | Joel A Lardizabal | Internal Medicine | 35 Casa St Ste 340, San Luis Obispo, CA 93405-1894 | 2006-09-11 |
| 1770543373 | Mark C Bocchicchio | Internal Medicine | 1941 Johnson Ave Ste 101, San Luis Obispo, CA 93401-4154 | 2006-03-27 |
| 1407122823 | Jennifer Anne Springer | Internal Medicine | 1941 Johnson Ave Ste 101, San Luis Obispo, CA 93401 | 2012-03-29 |
| 1265606081 | Kenneth Stevens Md Inc A Medical Corporation | Internal Medicine | 3231 S Higuera St, San Luis Obispo, CA 93401-6924 | 2008-04-14 |
| 1679750574 | Armin J Bandari | Internal Medicine | 1941 Johnson Ave, Ste 101, San Luis Obispo, CA 93401-4154 | 2008-01-23 |
| 1396924189 | Kenneth P Tway | Internal Medicine | 1106 Pacific St, San Luis Obispo, CA 93401-3302 | 2007-10-29 |
| 1215138789 | Andrea Hardison Tackett | Internal Medicine | 1941 Johnson Ave, Ste 101, San Luis Obispo, CA 93401-4154 | 2007-05-30 |
| 1689792327 | Christopher Paul Porterfield | Internal Medicine | 1941 Johnson Ave, Ste 101, San Luis Obispo, CA 93401-4154 | 2007-03-27 |
| 1720183569 | Coastal Cardiology A Medical Corp | Internal Medicine | 1941 Johnson Ave Ste 101, San Luis Obispo, CA 93401-4154 | 2006-09-14 |
| Find all providers in SAN LUIS OBISPO | ||||
| City | SAN LUIS OBISPO |
| Zip Code | 93401 |
Please comment or provide details below to improve the information on KENNETH STEVENS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.