Provider Demographics
NPI:1447212188
Name:FIERSTIEN, STEPHEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:FIERSTIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S DOHENY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2509
Mailing Address - Country:US
Mailing Address - Phone:310-550-5858
Mailing Address - Fax:310-550-5775
Practice Address - Street 1:145 S DOHENY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2509
Practice Address - Country:US
Practice Address - Phone:310-550-5858
Practice Address - Fax:310-550-5775
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG210402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G210400OtherBLUE SHIELD
CA00G210400OtherBLUE SHIELD
CAWG21040MMedicare ID - Type UnspecifiedMEDICARE PPIN