MEDICARE: SIENNA MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	20A7951	CA

General Provider Information

NPI Number	:	1174684583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIENNA MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	6425 LYNCH CANYON DR
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240-9726
Country	:	US
Telephone Number	:	760-379-8630
Fax Number	:	760-379-7658

Provider Business Practice Location Address
First Line	:	6425 LYNCH CYN BLVD
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240
Country	:	US
Telephone Number	:	760-379-8630
Fax Number	:	760-379-7658

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	ROBERT GROSS
Credential	:
Telephone Number	:	760-379-8630

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	05/22/2026

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