Provider Demographics
NPI:1073169991
Name:NAVASAK, SIERA
Entity Type:Individual
Prefix:
First Name:SIERA
Middle Name:
Last Name:NAVASAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6024
Mailing Address - Country:US
Mailing Address - Phone:760-433-3736
Mailing Address - Fax:
Practice Address - Street 1:4451 SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6024
Practice Address - Country:US
Practice Address - Phone:760-822-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility