Healthcare Provider Details

I. General information

NPI: 1629228978
Provider Name (Legal Business Name): TALIA M SIERRA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TALIA MARIE FROST

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 W USTICK RD STE 110
MERIDIAN ID
83646-7740
US

IV. Provider business mailing address

1510 W USTICK RD STE 110
MERIDIAN ID
83646-7740
US

V. Phone/Fax

Practice location:
  • Phone: 208-295-0297
  • Fax: 208-906-0954
Mailing address:
  • Phone: 208-295-0297
  • Fax: 208-906-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-768
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: