Provider Demographics
NPI:1346369709
Name:STESIN, ALAN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:STESIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:465 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2734
Mailing Address - Country:US
Mailing Address - Phone:415-456-7417
Mailing Address - Fax:415-456-7417
Practice Address - Street 1:1531 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3310
Practice Address - Country:US
Practice Address - Phone:530-332-7375
Practice Address - Fax:530-893-6808
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG39760207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE75068Medicare UPIN