MEDICARE: ANDRES SAMUEL FIERRO DTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	136A00000X	Registered Dietetic Technician

General Provider Information

NPI Number	:	1255903886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES SAMUEL FIERRO DTR

Provider Business Mailing Address
First Line	:	40171 W ROBBINS DR
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-6749
Country	:	US
Telephone Number	:	602-321-4497
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1211
Country	:	US
Telephone Number	:	480-681-0458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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