Healthcare Provider Details

I. General information

NPI: 1043406861
Provider Name (Legal Business Name): CIRSELDA ANIAG SIQUIAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2007
Last Update Date: 09/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23070 SISKIN CT
GRAND TERRACE CA
92313-5338
US

IV. Provider business mailing address

23070 SISKIN CT
GRAND TERRACE CA
92313-5338
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-8842
  • Fax:
Mailing address:
  • Phone: 909-825-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN473888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: