MEDICARE: CHRISTIAN YEOJ SISON NP

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	363LG0600X	Gerontology Nurse Practitioner	95009656	CA
2	363LP2300X	Primary Care Nurse Practitioner	95009656	CA
3	363LA2200X	Adult Health Nurse Practitioner	95009656	CA

General Provider Information

NPI Number	:	1912481300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN YEOJ SISON NP

Provider Business Mailing Address
First Line	:	91 THREE VINES CT
Second Line	:
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-0408
Country	:	US
Telephone Number	:	949-939-8629
Fax Number	:

Provider Business Practice Location Address
First Line	:	8142 FIRESTONE BLVD
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90241-4231
Country	:	US
Telephone Number	:	562-869-8621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

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