Basic Information
| Provider Information | |||||||||
| NPI: | 1942356795 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PLAXE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 WEST ARBOR DRIVE | ||||||||
| Address2: | MC 8201 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921038201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586578745 | ||||||||
| FaxNumber: | 8586578666 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 WEST ARBOR DRIVE | ||||||||
| Address2: | MC 8201 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921038201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586578745 | ||||||||
| FaxNumber: | 8586578666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 05/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | G64817 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00G648170 | 05 | CA | MEDICAID |