Healthcare Provider Details

I. General information

NPI: 1649819509
Provider Name (Legal Business Name): NURIA SISTERNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2019
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 W MEEKER BLVD
SUN CITY WEST AZ
85375-5282
US

IV. Provider business mailing address

14502 W MEEKER BLVD
SUN CITY WEST AZ
85375-5282
US

V. Phone/Fax

Practice location:
  • Phone: 623-524-8814
  • Fax:
Mailing address:
  • Phone: 623-524-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number66990
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number66990
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: