Basic Information
| Provider Information | |||||||||
| NPI: | 1437252905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIERRA | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4004 BEYER BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN YSIDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921732007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194284463 | ||||||||
| FaxNumber: | 6194282625 | ||||||||
| Practice Location | |||||||||
| Address1: | 865 3RD AVE | ||||||||
| Address2: | SUITE 133 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919111300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194986200 | ||||||||
| FaxNumber: | 6194270134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A93042 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | FHC70394F | 01 | MEDI-CAL | OTHER |