Provider Demographics
NPI:1770924045
Name:SIDA, SERGIO LUIS JR
Entity type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:LUIS
Last Name:SIDA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 SHERWIN LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-6740
Mailing Address - Country:US
Mailing Address - Phone:702-610-1698
Mailing Address - Fax:707-720-1501
Practice Address - Street 1:1614 SHERWIN LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-6740
Practice Address - Country:US
Practice Address - Phone:702-610-1698
Practice Address - Fax:707-720-1501
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner