Provider Demographics
NPI:1033172374
Name:FIERRO, MARIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:A
Last Name:FIERRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 BANDERA RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5616
Mailing Address - Country:US
Mailing Address - Phone:210-450-7334
Mailing Address - Fax:210-450-2124
Practice Address - Street 1:10350 BANDERA RD STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5616
Practice Address - Country:US
Practice Address - Phone:210-450-7334
Practice Address - Fax:210-450-2124
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5734208000000X, 2080P0006X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157726401Medicaid
TX157726401Medicaid