Healthcare Provider Details

I. General information

NPI: 1326849779
Provider Name (Legal Business Name): SIERRA HEGLE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 SAN DIEGO AVE STE 101
SAN DIEGO CA
92110-2907
US

IV. Provider business mailing address

11233 TIERRASANTA BLVD UNIT 38
SAN DIEGO CA
92124-2800
US

V. Phone/Fax

Practice location:
  • Phone: 619-779-0078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: