Provider Demographics
NPI:1205831161
Name:FIERER, ADAM S (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:FIERER
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 1:2385 S MELROSE DR
Mailing Address - Street 2:STE C300
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8788
Mailing Address - Country:US
Mailing Address - Phone:760-300-3647
Mailing Address - Fax:760-482-1316
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:STE C200
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4500
Practice Address - Country:US
Practice Address - Phone:760-724-5352
Practice Address - Fax:760-724-5447
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2017-03-27
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CAG69685208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G696850Medicaid
CAG31650Medicare UPIN
CA00G696850Medicaid