Healthcare Provider Details

I. General information

NPI: 1013863182
Provider Name (Legal Business Name): JOSUE E SIBRIAN PETE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11866 KILLIMORE AVE
PORTER RANCH CA
91326-1957
US

IV. Provider business mailing address

11866 KILLIMORE AVE
PORTER RANCH CA
91326-1957
US

V. Phone/Fax

Practice location:
  • Phone: 818-903-6705
  • Fax:
Mailing address:
  • Phone: 818-903-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: