Basic Information
Provider Information | |||||||||
NPI: | 1144336447 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STEELE | ||||||||
FirstName: | C. | ||||||||
MiddleName: | HAMILTON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8851 CENTER DR | ||||||||
Address2: | #500 | ||||||||
City: | LA MESA | ||||||||
State: | CA | ||||||||
PostalCode: | 919423017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6194612660 | ||||||||
FaxNumber: | 6194615760 | ||||||||
Practice Location | |||||||||
Address1: | 8851 CENTER DR | ||||||||
Address2: | #500 | ||||||||
City: | LA MESA | ||||||||
State: | CA | ||||||||
PostalCode: | 919423017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6194612660 | ||||||||
FaxNumber: | 6194615760 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/21/2006 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G 32928 | CA | Y |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 00G329280 | 01 | CA | MEDI-CAL | OTHER | AS 7250981 | 01 | CA | BNDD | OTHER |