Provider Demographics
NPI:1922763200
Name:GIDEON, SIANNA JOYCE
Entity Type:Individual
Prefix:
First Name:SIANNA
Middle Name:JOYCE
Last Name:GIDEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50065 9450 GILMAN DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92092-0001
Mailing Address - Country:US
Mailing Address - Phone:909-419-6609
Mailing Address - Fax:
Practice Address - Street 1:3550 CAMINO DEL RIO N
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1737
Practice Address - Country:US
Practice Address - Phone:909-419-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician