Healthcare Provider Details

I. General information

NPI: 1912862681
Provider Name (Legal Business Name): CRISTAL LIZBETH PEREZ SIERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 SKYLANE BLVD
SANTA ROSA CA
95403-8246
US

IV. Provider business mailing address

5340 SKYLANE BLVD
SANTA ROSA CA
95403-1082
US

V. Phone/Fax

Practice location:
  • Phone: 707-524-2710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberC8F5FA17A9
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: