Provider Demographics
NPI:1063427425
Name:FIERRO, NANCY LANDIS (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LANDIS
Last Name:FIERRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2328
Mailing Address - Country:US
Mailing Address - Phone:760-479-3900
Mailing Address - Fax:760-753-8175
Practice Address - Street 1:477 N EL CAMINO REAL STE A208
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1329
Practice Address - Country:US
Practice Address - Phone:760-479-3900
Practice Address - Fax:760-753-8175
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G771460Medicaid
CA00G771460Medicaid
CAWG77146BMedicare ID - Type Unspecified