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Steven E Henderson

Emergency Medicine

Allopathic & Osteopathic Physicians

10710 N Torrey Pines Rd, La Jolla, CA 92037-1035

PECOS Enrollment

This provider is enrolled in PECOS as STEVEN HENDERSON.

Based on the most recent information from CMS, provider Steven E Henderson is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:37 AM.

Profile Details

Provider ID
1255353835
Provider Type
Individual
Full Name
Henderson, Steven E
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
7/24/2006
Last Updated
2/26/2020

Contact Information

Practice Location

10710 N Torrey Pines Rd, La Jolla, CA 92037-1035

(858) 554-8638

Unlisted Fax

Mailing Location

10790 Rancho Bernardo Rd, San Diego, CA 92127-5705

(858) 554-8638

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License A42695 California

Provider Identifiers

ID	Description	Issuer
ID 00A428950	Description Medicaid	Issuer Unlisted California

Steven E Henderson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Tong, Tri C

Demott, Megan C

Lippi, Matthew W

Villani, Heather Renee

Wayment, Andrew Michael

Eagle, Sonja Zoe Opal

Regents Of The Unviersity Of California

Westneat, Laura Elinor

Chan, Theodore C

Mellon, Monte Tim