Provider Demographics
NPI:1770562431
Name:HIERRO, MARTHA E (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:E
Last Name:HIERRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:STE 335E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2146
Mailing Address - Country:US
Mailing Address - Phone:310-471-9917
Mailing Address - Fax:310-319-2468
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:STE 335E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2146
Practice Address - Country:US
Practice Address - Phone:310-471-9917
Practice Address - Fax:310-319-2468
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG65495207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G654950Medicaid
CAF62390Medicare UPIN
CA00G654950Medicaid