Healthcare Provider Details

I. General information

NPI: 1407215544
Provider Name (Legal Business Name): SIENNA PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 LYNCH CANYON DR.
LAKE ISABELLA CA
93240-9726
US

IV. Provider business mailing address

6425 LYNCH CANYON DR.
LAKE ISABELLA CA
93240-9726
US

V. Phone/Fax

Practice location:
  • Phone: 760-379-8630
  • Fax: 760-379-7658
Mailing address:
  • Phone: 760-379-8630
  • Fax: 760-379-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4349
License Number StateCA

VIII. Authorized Official

Name: DR. HOLLY A SPOHN-GROSS
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 760-379-8630