Provider Demographics
NPI:1265453815
Name:MOULTON, SIERRA ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:SIERRA
Middle Name:ANNE
Last Name:MOULTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1967 GILLILAN ST
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2006
Mailing Address - Country:US
Mailing Address - Phone:714-528-8997
Mailing Address - Fax:
Practice Address - Street 1:1045 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5904
Practice Address - Country:US
Practice Address - Phone:714-288-8303
Practice Address - Fax:714-744-1991
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine