Provider Demographics
NPI:1043894041
Name:SIERRA, LUIS MANUEL
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:SIERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4510
Mailing Address - Country:US
Mailing Address - Phone:305-377-3297
Mailing Address - Fax:
Practice Address - Street 1:6911 MIAMI LAKEWAY S
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2925
Practice Address - Country:US
Practice Address - Phone:786-449-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator