Healthcare Provider Details

I. General information

NPI: 1396060786
Provider Name (Legal Business Name): HEATHER MARIE SIEFKES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD TICON II
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

2516 STOCKTON BLVD TICON II
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7840
  • Fax: 916-456-2235
Mailing address:
  • Phone: 916-734-7840
  • Fax: 916-456-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA142130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: