Provider Demographics
NPI:1962573964
Name:PENA, SIERRA (MD)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:PENA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PEACH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2869
Mailing Address - Country:US
Mailing Address - Phone:805-543-4043
Mailing Address - Fax:
Practice Address - Street 1:1250 PEACH ST STE B
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2869
Practice Address - Country:US
Practice Address - Phone:805-543-4043
Practice Address - Fax:805-543-7640
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039993207Q00000X
CAC193631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine