Provider Demographics
NPI:1750133856
Name:SIFUENTES, ANGELA RUSSELL SCOTT (HAD)
Entity type:Individual
Prefix:
First Name:ANGELA RUSSELL
Middle Name:SCOTT
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 W NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-1844
Mailing Address - Country:US
Mailing Address - Phone:559-471-4692
Mailing Address - Fax:
Practice Address - Street 1:3545 W NOBLE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-1844
Practice Address - Country:US
Practice Address - Phone:559-471-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8378237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist