1629185418 NPI number — SIERRA INFECTIOUS DISEASES A PROFESSIONAL MEDICAL CORPORATION

Table of content: TRACY ANN TADDEY DDS (NPI 1831109883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629185418 NPI number — SIERRA INFECTIOUS DISEASES A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA INFECTIOUS DISEASES A PROFESSIONAL MEDICAL CORPORATION
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:
Provider Other Organization Name Type Code:
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:
1629185418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6614 MERCY CT
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FAIR OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95628-3167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-536-1136
Provider Business Mailing Address Fax Number:
916-536-1148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6614 MERCY CT
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-536-1136
Provider Business Practice Location Address Fax Number:
916-536-1148
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAILATH
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
916-536-1136

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A41552 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: A41552 , 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)





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