Provider Demographics
NPI:1558066449
Name:SIERRA, LUISA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:LUISA
Other - Middle Name:
Other - Last Name:SIERRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2019 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6303
Mailing Address - Country:US
Mailing Address - Phone:818-770-1248
Mailing Address - Fax:
Practice Address - Street 1:13754 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2324
Practice Address - Country:US
Practice Address - Phone:818-616-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024716363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner