| Doctor Name: | STEPHEN G. PROVONSHA |
| NPI Number: | 1598836413 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | G51217 |
| Business Practice Address: | 10800 Magnolia Ave Riverside, CA - 925053043 |
| Business Phone Number: | 9093532000 |
| Business Fax Number: | |
| Mailing Address: | 10800 Magnolia Ave, RIVERSIDE |
| State: | CA |
| Postal Code: | 925053043 |
| Phone Number: | 9093532000 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 09/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G51217 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |