Provider Demographics
NPI:1942800180
Name:SIERRA, CAROLINA YSIBEL (LN)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:YSIBEL
Last Name:SIERRA
Suffix:
Gender:F
Credentials:LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 CONNECTICUT AVE NW APT 316
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2516
Mailing Address - Country:US
Mailing Address - Phone:301-503-0919
Mailing Address - Fax:
Practice Address - Street 1:3912 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5861
Practice Address - Country:US
Practice Address - Phone:202-729-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5103133N00000X
DCNU10000228133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist