Provider Demographics
NPI:1164030185
Name:SIANEZ, DOLLY
Entity Type:Individual
Prefix:
First Name:DOLLY
Middle Name:
Last Name:SIANEZ
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 1:1090 E CYPRESS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1163
Mailing Address - Country:US
Mailing Address - Phone:530-223-2332
Mailing Address - Fax:530-223-4721
Practice Address - Street 1:1090 E CYPRESS AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1163
Practice Address - Country:US
Practice Address - Phone:530-223-2332
Practice Address - Fax:530-223-4721
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272631164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse