Provider Demographics
NPI:1487297107
Name:SIPRA, FAREEHA (NURSE PRACTIONER)
Entity type:Individual
Prefix:
First Name:FAREEHA
Middle Name:
Last Name:SIPRA
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 M ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1805
Mailing Address - Country:US
Mailing Address - Phone:559-600-9360
Mailing Address - Fax:
Practice Address - Street 1:2029 CENTURY PARK E STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2905
Practice Address - Country:US
Practice Address - Phone:559-259-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013049363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95013049Medicaid