Healthcare Provider Details

I. General information

NPI: 1487639001
Provider Name (Legal Business Name): JOSEPH I. SISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 AUBURN BLVD
SACRAMENTO CA
95841-4100
US

IV. Provider business mailing address

PO BOX 19735
SACRAMENTO CA
95819-0735
US

V. Phone/Fax

Practice location:
  • Phone: 916-529-3907
  • Fax:
Mailing address:
  • Phone: 916-529-3907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG71704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: