Healthcare Provider Details

I. General information

NPI: 1184720112
Provider Name (Legal Business Name): STEVE RANDAL EJERCITO FIRME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEVE EJERCITO FIRME M.D.

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 E FOOTHILL BLVD STE 102
UPLAND CA
91786-4068
US

IV. Provider business mailing address

1719 N TULARE WAY
UPLAND CA
91784-1961
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-5738
  • Fax: 909-981-4577
Mailing address:
  • Phone: 909-949-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-056921-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83197
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA056129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: