Provider Demographics
NPI:1912146515
Name:SIERRA, OSCAR (LAC)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:SIERRA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 PHARR COURT NORTH NW
Mailing Address - Street 2:APT. J5
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2045
Mailing Address - Country:US
Mailing Address - Phone:678-361-6523
Mailing Address - Fax:
Practice Address - Street 1:2964 PEACHTREE RD NW
Practice Address - Street 2:STE. 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2153
Practice Address - Country:US
Practice Address - Phone:678-361-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist