Provider Demographics
NPI:1225305618
Name:SIANIPAR, EDWARD N (NP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:N
Last Name:SIANIPAR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19059 BEAR VALLEY RD.
Mailing Address - Street 2:#1
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308
Mailing Address - Country:US
Mailing Address - Phone:760-515-5000
Mailing Address - Fax:760-240-3848
Practice Address - Street 1:19059 BEAR VALLEY RD.
Practice Address - Street 2:#1
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308
Practice Address - Country:US
Practice Address - Phone:760-515-5000
Practice Address - Fax:760-240-3848
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21409363LA2200X
CANP21409363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health