Healthcare Provider Details

I. General information

NPI: 1982852562
Provider Name (Legal Business Name): MICHELLE DIANA FIERRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E 1ST ST SUITE 100
SANTA ANA CA
92701-6342
US

IV. Provider business mailing address

1514 W TEDMAR AVE
ANAHEIM CA
92802-1341
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-3700
  • Fax:
Mailing address:
  • Phone: 714-535-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: