1205831161 NPI number — ADAM S FIERER MD

Table of content: (NPI 1851592950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205831161 NPI number — ADAM S FIERER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIERER
Provider First Name:
ADAM
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205831161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/18/2006
NPI Reactivation Date:
03/24/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2385 S MELROSE DR
Provider Second Line Business Mailing Address:
STE C300
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92081-8788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-300-3647
Provider Business Mailing Address Fax Number:
760-482-1316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3998 VISTA WAY
Provider Second Line Business Practice Location Address:
STE C200
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-724-5352
Provider Business Practice Location Address Fax Number:
760-724-5447
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G69685 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G696850 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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