Healthcare Provider Details

I. General information

NPI: 1952256703
Provider Name (Legal Business Name): PRISKA SIREGAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11611 ZOELLER ST
BEAUMONT CA
92223-5313
US

IV. Provider business mailing address

11611 ZOELLER ST
BEAUMONT CA
92223-5313
US

V. Phone/Fax

Practice location:
  • Phone: 916-745-9263
  • Fax:
Mailing address:
  • Phone: 916-745-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95034661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: