Provider Demographics
NPI:1407573223
Name:FIERRO, MARIELA (LD)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:FIERRO
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12338 WILLS CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7678
Mailing Address - Country:US
Mailing Address - Phone:915-526-0430
Mailing Address - Fax:
Practice Address - Street 1:12338 WILLS CRESCENT CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-7678
Practice Address - Country:US
Practice Address - Phone:915-526-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88084133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education