Provider Demographics
NPI:1346964178
Name:SIORDIA SURGICAL ASSISTING
Entity Type:Organization
Organization Name:SIORDIA SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT CERTIFIED
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIORDIA
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:505-304-5165
Mailing Address - Street 1:2319 VISTA DE COLINAS DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2949
Mailing Address - Country:US
Mailing Address - Phone:505-304-5165
Mailing Address - Fax:
Practice Address - Street 1:2319 VISTA DE COLINAS DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2949
Practice Address - Country:US
Practice Address - Phone:505-304-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty