Provider Demographics
NPI:1467122960
Name:SINFUEGO, PRISCO SAWAL JR
Entity Type:Individual
Prefix:
First Name:PRISCO
Middle Name:SAWAL
Last Name:SINFUEGO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 N NOTTINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-3825
Mailing Address - Country:US
Mailing Address - Phone:773-541-0321
Mailing Address - Fax:
Practice Address - Street 1:2119 E HATCH RD STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-4814
Practice Address - Country:US
Practice Address - Phone:209-812-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist