Provider Demographics
NPI:1336367952
Name:SIERRA-NIEVES, LUIS (PAC)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:SIERRA-NIEVES
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4958
Mailing Address - Country:US
Mailing Address - Phone:972-262-8211
Mailing Address - Fax:972-226-2831
Practice Address - Street 1:710 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4958
Practice Address - Country:US
Practice Address - Phone:972-262-8211
Practice Address - Fax:972-226-2831
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP54350Medicare UPIN