MEDICARE: MR. GUSTAVO FIERRO MSW, CATVIV

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	101YM0800X	Mental Health Counselor	ASW63482	CA
2	104100000X	Social Worker	ASW63482	CA

General Provider Information

NPI Number	:	1588756829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GUSTAVO FIERRO MSW, CATVIV

Provider Business Mailing Address
First Line	:	12592 MAGNOLIA DR
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92555-3513
Country	:	US
Telephone Number	:	562-355-0017
Fax Number	:

Provider Business Practice Location Address
First Line	:	9890 COUNTY FARM RD BLDG C
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3678
Country	:	US
Telephone Number	:	951-509-8320
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	05/23/2023

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