Provider Demographics
NPI:1588612154
Name:WASSERMAN, STEPHEN IRA (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:IRA
Last Name:WASSERMAN
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 1:2361 ALMERIA CT
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7201
Mailing Address - Country:US
Mailing Address - Phone:858-822-4261
Mailing Address - Fax:858-534-7517
Practice Address - Street 1:9350 CAMPUS POINT DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:858-657-8322
Practice Address - Fax:858-534-7517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23431207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology