Healthcare Provider Details

I. General information

NPI: 1912481300
Provider Name (Legal Business Name): CHRISTIAN YEOJ SISON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8142 FIRESTONE BLVD
DOWNEY CA
90241-4231
US

IV. Provider business mailing address

91 THREE VINES CT
LADERA RANCH CA
92694-0408
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-8621
  • Fax:
Mailing address:
  • Phone: 949-939-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95009656
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95009656
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95009656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: