Provider Demographics
NPI:1487002010
Name:FERNBACH, STEPHEN ALTON (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALTON
Last Name:FERNBACH
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 1:755 THORSEN CT
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6630
Mailing Address - Country:US
Mailing Address - Phone:650-941-6514
Mailing Address - Fax:
Practice Address - Street 1:755 THORSEN CT
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6630
Practice Address - Country:US
Practice Address - Phone:650-941-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG217562080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine