Healthcare Provider Details

I. General information

NPI: 1932572021
Provider Name (Legal Business Name): MORENA GUADALUPE SIERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 1/2 N ARDMORE AVE
LOS ANGELES CA
90029-3311
US

IV. Provider business mailing address

731 1/2 N ARDMORE AVE
LOS ANGELES CA
90029-3311
US

V. Phone/Fax

Practice location:
  • Phone: 310-425-6872
  • Fax: 213-989-0154
Mailing address:
  • Phone: 310-425-6872
  • Fax: 213-989-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: