Healthcare Provider Details

I. General information

NPI: 1982714119
Provider Name (Legal Business Name): ANN M. SIEFERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 YNEZ PL STE A
CORONADO CA
92118-3909
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-8645
  • Fax:
Mailing address:
  • Phone: 619-437-1791
  • Fax: 619-435-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG69268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: