Healthcare Provider Details

I. General information

NPI: 1881992188
Provider Name (Legal Business Name): SARA CIFUENTES BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 ARCH ST 6TH FLR
PHILADELPHIA PA
19107-2835
US

IV. Provider business mailing address

4601 MARKET ST
PHILADELPHIA PA
19139-4636
US

V. Phone/Fax

Practice location:
  • Phone: 215-981-0088
  • Fax:
Mailing address:
  • Phone: 267-418-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN744259
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: