Healthcare Provider Details

I. General information

NPI: 1356223853
Provider Name (Legal Business Name): SIERRA GAGE RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19100 VON KARMAN AVE STE 260
IRVINE CA
92612-6557
US

IV. Provider business mailing address

19100 VON KARMAN AVE STE 260
IRVINE CA
92612-6557
US

V. Phone/Fax

Practice location:
  • Phone: 949-868-5004
  • Fax:
Mailing address:
  • Phone: 949-868-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95036820
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2390264
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95420052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: