Provider Demographics
NPI:1578337671
Name:SIFUENTES BRITO, DAVID MARTIN (CMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARTIN
Last Name:SIFUENTES BRITO
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 N EAST ST SPC 214
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1139
Mailing Address - Country:US
Mailing Address - Phone:714-273-5534
Mailing Address - Fax:
Practice Address - Street 1:1100 E ORANGETHORPE AVE STE 252G
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1164
Practice Address - Country:US
Practice Address - Phone:714-273-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94414225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist