Provider Demographics
NPI:1225586258
Name:SISNEROS, CONTESSA (PA-C)
Entity Type:Individual
Prefix:
First Name:CONTESSA
Middle Name:
Last Name:SISNEROS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CONTESSA
Other - Middle Name:
Other - Last Name:STRODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2730 SW MOODY AVE # CL5PA
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5042
Mailing Address - Country:US
Mailing Address - Phone:503-494-3633
Mailing Address - Fax:
Practice Address - Street 1:530 NW 27TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5223
Practice Address - Country:US
Practice Address - Phone:541-766-6835
Practice Address - Fax:541-766-6186
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA190185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty