Provider Demographics
NPI:1669348090
Name:FIESTA, ERIC ROLLY SEBASTIAN
Entity type:Individual
Prefix:
First Name:ERIC ROLLY
Middle Name:SEBASTIAN
Last Name:FIESTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 LITTLE MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1928
Mailing Address - Country:US
Mailing Address - Phone:951-563-5729
Mailing Address - Fax:
Practice Address - Street 1:4471 LITTLE MEADOW CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-1928
Practice Address - Country:US
Practice Address - Phone:951-563-5729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3747P1801X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant