Provider Demographics
NPI:1255903886
Name:FIERRO, ANDRES SAMUEL (DTR)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:SAMUEL
Last Name:FIERRO
Suffix:
Gender:M
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40171 W ROBBINS DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-6749
Mailing Address - Country:US
Mailing Address - Phone:602-321-4497
Mailing Address - Fax:
Practice Address - Street 1:6520 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1211
Practice Address - Country:US
Practice Address - Phone:480-681-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered