Healthcare Provider Details

I. General information

NPI: 1417779430
Provider Name (Legal Business Name): SIERRA FRANK IGNACIO MSW, LSAA, CADS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PINON AND COTTONWOOD DRIVE BLDG 2301
SHIPROCK NM
87420
US

IV. Provider business mailing address

PO 1830
SHIPROCK NM
87420
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-1461
  • Fax:
Mailing address:
  • Phone: 505-368-1452
  • Fax: 505-368-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCADS22005
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0093
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: