Healthcare Provider Details

I. General information

NPI: 1336005578
Provider Name (Legal Business Name): ALICIA DEBORAH SISCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

IV. Provider business mailing address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

V. Phone/Fax

Practice location:
  • Phone: 714-410-3500
  • Fax:
Mailing address:
  • Phone: 714-410-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number292860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: