Provider Demographics
NPI:1508834888
Name:SIBAL, NERISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:NERISSA
Middle Name:
Last Name:SIBAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 BLOOMFIELD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-961-0155
Mailing Address - Fax:562-961-0161
Practice Address - Street 1:11401 BLOOMFIELD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-961-0155
Practice Address - Fax:562-961-0161
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA806532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA80653AMedicare ID - Type Unspecified
CAI09683Medicare UPIN