Provider Demographics
NPI:1013774470
Name:SENGSOURITH, ANNALISA
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:SENGSOURITH
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 1:3024 MCKEAN DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3037
Mailing Address - Country:US
Mailing Address - Phone:510-684-4526
Mailing Address - Fax:
Practice Address - Street 1:3024 MCKEAN DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-3037
Practice Address - Country:US
Practice Address - Phone:510-684-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst