1992713085 NPI number — SIERRA GASTROENTEROLOGY

Table of content: (NPI 1992713085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992713085 NPI number — SIERRA GASTROENTEROLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA GASTROENTEROLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
S.E.MOORTHY MD INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992713085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44725 10TH ST W
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-945-1874
Provider Business Mailing Address Fax Number:
661-945-2584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44725 10TH ST W STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-945-1874
Provider Business Practice Location Address Fax Number:
661-945-2584
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORTHY
Authorized Official First Name:
SINNADURAI
Authorized Official Middle Name:
EARAMPA
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
661-945-1874

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A29707 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0024400 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com