Provider Demographics
NPI:1760877120
Name:FISH, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:FISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44139 MONTEREY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-8700
Mailing Address - Country:US
Mailing Address - Phone:607-779-0801
Mailing Address - Fax:884-897-3788
Practice Address - Street 1:44139 MONTEREY AVE STE A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-8700
Practice Address - Country:US
Practice Address - Phone:760-779-0800
Practice Address - Fax:848-973-7888
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA164497207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program