Healthcare Provider Details

I. General information

NPI: 1346964178
Provider Name (Legal Business Name): SIORDIA SURGICAL ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 VISTA DE COLINAS DR SE
RIO RANCHO NM
87124-2949
US

IV. Provider business mailing address

2319 VISTA DE COLINAS DR SE
RIO RANCHO NM
87124-2949
US

V. Phone/Fax

Practice location:
  • Phone: 505-304-5165
  • Fax:
Mailing address:
  • Phone: 505-304-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. CORINA SIORDIA
Title or Position: SURGICAL ASSISTANT CERTIFIED
Credential: SA-C
Phone: 505-304-5165