Healthcare Provider Details

I. General information

NPI: 1306279344
Provider Name (Legal Business Name): LAURA JANE SIFUENTES DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 RIVER PARK DR
SACRAMENTO CA
95815-4601
US

IV. Provider business mailing address

10390 COLOMA RD STE 7
RANCHO CORDOVA CA
95670-2152
US

V. Phone/Fax

Practice location:
  • Phone: 916-286-1000
  • Fax: 916-858-0972
Mailing address:
  • Phone: 916-858-0950
  • Fax: 916-858-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT40299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: