Provider Demographics
NPI:1588756829
Name:FIERRO, GUSTAVO (MSW, CATVIV)
Entity type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:
Last Name:FIERRO
Suffix:
Gender:M
Credentials:MSW, CATVIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12592 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3513
Mailing Address - Country:US
Mailing Address - Phone:562-355-0017
Mailing Address - Fax:
Practice Address - Street 1:9890 COUNTY FARM RD BLDG C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3678
Practice Address - Country:US
Practice Address - Phone:951-509-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW63482101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health