Healthcare Provider Details

I. General information

NPI: 1275960882
Provider Name (Legal Business Name): MICHAEL JOHN SALVANA SISON RN, NP, RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11910 IRWINDALE AVE
BAKERSFIELD CA
93312-6496
US

IV. Provider business mailing address

11910 IRWINDALE AVE
BAKERSFIELD CA
93312-6496
US

V. Phone/Fax

Practice location:
  • Phone: 661-444-0889
  • Fax:
Mailing address:
  • Phone: 661-444-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN740119
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032547
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN740119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: