Provider Demographics
NPI:1104029404
Name:VICTORIA FIERRO MD PA
Entity type:Organization
Organization Name:VICTORIA FIERRO MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:FIERRO-COBAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-336-0300
Mailing Address - Street 1:10200 NW 25TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5921
Mailing Address - Country:US
Mailing Address - Phone:786-336-0300
Mailing Address - Fax:786-336-0332
Practice Address - Street 1:10200 NW 25TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5921
Practice Address - Country:US
Practice Address - Phone:786-336-0300
Practice Address - Fax:786-336-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77153208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269038100Medicaid
H67556Medicare UPIN