Provider Demographics
NPI:1871059014
Name:MASSANU SIRLEAF INC.
Entity type:Organization
Organization Name:MASSANU SIRLEAF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MASSANU
Authorized Official - Middle Name:ARISBE
Authorized Official - Last Name:SIRLEAF
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC
Authorized Official - Phone:414-704-3022
Mailing Address - Street 1:5138 NEW RANCH RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-8269
Mailing Address - Country:US
Mailing Address - Phone:414-704-3022
Mailing Address - Fax:619-567-2455
Practice Address - Street 1:5138 NEW RANCH RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-8269
Practice Address - Country:US
Practice Address - Phone:414-704-3022
Practice Address - Fax:619-567-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty