Provider Demographics
NPI:1205374766
Name:SIFUENTEZ, OLIVIA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:SIFUENTEZ
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 1:2313 W SYLVESTER ST
Mailing Address - Street 2:APT C3
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2313 W SYLVESTER ST
Practice Address - Street 2:APT C3
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4587
Practice Address - Country:US
Practice Address - Phone:509-205-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60715818225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist