Healthcare Provider Details

I. General information

NPI: 1316803661
Provider Name (Legal Business Name): ALEXIS NIEVES SIERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10827 E RENATA CIR
MESA AZ
85212-2522
US

IV. Provider business mailing address

10827 E RENATA CIR
MESA AZ
85212-2522
US

V. Phone/Fax

Practice location:
  • Phone: 602-882-8828
  • Fax:
Mailing address:
  • Phone: 602-882-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: