Provider Demographics
NPI:1962725382
Name:SIRLEAF, MASSANU ARISBE (ARNP)
Entity type:Individual
Prefix:
First Name:MASSANU
Middle Name:ARISBE
Last Name:SIRLEAF
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15788
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92175-5788
Mailing Address - Country:US
Mailing Address - Phone:858-278-8110
Mailing Address - Fax:858-810-7196
Practice Address - Street 1:1351 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5811
Practice Address - Country:US
Practice Address - Phone:414-704-3022
Practice Address - Fax:619-567-2455
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC236467363LA2100X
NC5004684363LA2100X
FL9237954363LA2100X
CA95000692363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1962725382Medicaid
CACB248737OtherMEDICARE PTAN
NC7005200Medicaid
SCNP1617Medicaid
NC2594776Medicare PIN