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NPI Code Detail

MEDICARE: JAVIER FIERRO JR.

MEDICARE: JAVIER FIERRO JR.
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1760945547
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAVIER FIERRO JR.
Provider Business Mailing Address
First Line : 1055 E COLORADO BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91106-2327
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5400 SUNCREST DR STE D1
Second Line :
City : EL PASO
State : TX
Zip : 79912-5615
Country : US
Telephone Number : 818-241-6780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2019
Last Update Date : 04/09/2019

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