Healthcare Provider Details

I. General information

NPI: 1104271675
Provider Name (Legal Business Name): MARIA CRISTINA DEL ROSARIO ALDANA SIERRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date: 12/21/2016
Reactivation Date: 01/19/2017

III. Provider practice location address

2120 N CENTRAL AVE
PHOENIX AZ
85004-1455
US

IV. Provider business mailing address

2108 E THOMAS RD
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 29-336-6100
  • Fax:
Mailing address:
  • Phone: 602-933-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number65371
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberMT217246
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number65371
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: