=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053616565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUISA A. FIERRO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2011
-----------------------------------------------------
Last Update Date | 07/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 670 N BEERS ST BLDG#2, #STE1
-----------------------------------------------------
City | HOLMDEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07733-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-226-5552
-----------------------------------------------------
Fax | 732-757-0824
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 670 N BEERS ST BLDG#2, #STE1
-----------------------------------------------------
City | HOLMDEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07733-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-226-5552
-----------------------------------------------------
Fax | 732-757-0824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 37578
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MA07263400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------