Provider Demographics
NPI:1407617202
Name:SIENNA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SIENNA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-379-8630
Mailing Address - Street 1:6425 LYNCH CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-9726
Mailing Address - Country:US
Mailing Address - Phone:760-379-8630
Mailing Address - Fax:760-379-7658
Practice Address - Street 1:1661 TRIANGLE DR STE A
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2614
Practice Address - Country:US
Practice Address - Phone:760-379-8630
Practice Address - Fax:760-379-7658
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIENNA MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty