Healthcare Provider Details

I. General information

NPI: 1427879444
Provider Name (Legal Business Name): SIERRA AMBER DUGGAN LCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 BROADWAY
SACRAMENTO CA
95817-3302
US

IV. Provider business mailing address

3810 BROADWAY
SACRAMENTO CA
95817-3302
US

V. Phone/Fax

Practice location:
  • Phone: 800-707-3358
  • Fax:
Mailing address:
  • Phone: 800-707-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: