Provider Demographics
NPI:1902671993
Name:SIFUENTES, MARIA L
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 CALDWELL BLVD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-6402
Mailing Address - Country:US
Mailing Address - Phone:208-591-9805
Mailing Address - Fax:
Practice Address - Street 1:3307 CALDWELL BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-6402
Practice Address - Country:US
Practice Address - Phone:208-591-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health