Provider Demographics
NPI:1063608008
Name:SIERRA, EDGAR (LMFT)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:SIERRA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MILE OF CARS WAY STE 350
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-6629
Mailing Address - Country:US
Mailing Address - Phone:858-967-5939
Mailing Address - Fax:
Practice Address - Street 1:3344 4TH AVE
Practice Address - Street 2:SUITE: 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5704
Practice Address - Country:US
Practice Address - Phone:619-354-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist