MEDICARE: MS. KAREN SUE SIFUENTES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	34543	CA
2	1041C0700X	Clinical Social Worker	76306	CA
3	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205117272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN SUE SIFUENTES

Provider Business Mailing Address
First Line	:	2412 ELMONT AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1556
Country	:	US
Telephone Number	:	916-904-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 ELMONT AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1556
Country	:	US
Telephone Number	:	916-485-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	06/05/2025

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