1639382773 NPI number — CATHY SAMPSON-SIRIANI MSN,RN,FNP

Table of content: CATHY SAMPSON-SIRIANI MSN,RN,FNP (NPI 1639382773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639382773 NPI number — CATHY SAMPSON-SIRIANI MSN,RN,FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMPSON-SIRIANI
Provider First Name:
CATHY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN,RN,FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639382773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3704 CANYON TERRACE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-357-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3704 CANYON TERRACE DR
Provider Second Line Business Practice Location Address:
9680 CITRUS AVE, BLGD#33 FONTANA, CA 92335
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92407-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-883-8585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  327377 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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