Provider Demographics
NPI:1407215544
Name:SIENNA PODIATRY PC
Entity type:Organization
Organization Name:SIENNA PODIATRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPOHN-GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-379-8630
Mailing Address - Street 1:6425 LYNCH CANYON DR.
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-9726
Mailing Address - Country:US
Mailing Address - Phone:760-379-8630
Mailing Address - Fax:760-379-7658
Practice Address - Street 1:6425 LYNCH CANYON DR.
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9726
Practice Address - Country:US
Practice Address - Phone:760-379-8630
Practice Address - Fax:760-379-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4349213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty