Provider Demographics
NPI:1124108196
Name:FIRESTONE, JORDAN AARON (MD, PHD, MPH)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:AARON
Last Name:FIRESTONE
Suffix:
Gender:M
Credentials:MD, PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 ESCUELA AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1812
Mailing Address - Country:US
Mailing Address - Phone:650-554-0844
Mailing Address - Fax:
Practice Address - Street 1:237 ESCUELA AVE UNIT B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1812
Practice Address - Country:US
Practice Address - Phone:650-554-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC546992083X0100X, 2084N0400X
WAMD000354802084N0400X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA130025374OtherRAILROAD MEDICARE
WA8257313Medicaid
H07144Medicare UPIN
AB12549Medicare ID - Type Unspecified
WA8257313Medicaid