Provider Demographics
NPI:1215667654
Name:SIFUENTES, DIANA ASUCENA (MS, EP-C)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ASUCENA
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:MS, EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 DUSTIN PLACE CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-5906
Mailing Address - Country:US
Mailing Address - Phone:936-553-8622
Mailing Address - Fax:
Practice Address - Street 1:2619 DUSTIN PLACE CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-5906
Practice Address - Country:US
Practice Address - Phone:936-553-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist