Provider Demographics
NPI:1932607876
Name:SIFUENTES, CRISTINA L (STNA)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:L
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2760
Mailing Address - Country:US
Mailing Address - Phone:567-225-2446
Mailing Address - Fax:
Practice Address - Street 1:1708 NEVADA ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2760
Practice Address - Country:US
Practice Address - Phone:567-225-2446
Practice Address - Fax:419-698-8126
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400596330307376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH400596330307OtherSTNA LICENSE