Provider Demographics
NPI:1568469245
Name:FIERRO-STEVENS, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:FIERRO-STEVENS
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 1:1400 N EL PASO ST
Mailing Address - Street 2:B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3437
Mailing Address - Country:US
Mailing Address - Phone:915-544-4911
Mailing Address - Fax:915-544-7610
Practice Address - Street 1:1400 N EL PASO ST
Practice Address - Street 2:B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3437
Practice Address - Country:US
Practice Address - Phone:915-544-4911
Practice Address - Fax:915-544-7610
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ41112084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000T15S8Medicaid
TXP000T15S8Medicaid