Healthcare Provider Details

I. General information

NPI: 1245916063
Provider Name (Legal Business Name): EMILY ELISABETH FIERRO ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 COFFEE RD
MODESTO CA
95355-4240
US

IV. Provider business mailing address

3905 COUGAR PL
MODESTO CA
95356-1337
US

V. Phone/Fax

Practice location:
  • Phone: 209-613-0207
  • Fax:
Mailing address:
  • Phone: 209-614-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000058671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: