1073647350 NPI number — CLINICA SIERRA VISTA

Table of content: (NPI 1073647350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073647350 NPI number — CLINICA SIERRA VISTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA SIERRA VISTA
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:
6
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:
1073647350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1559
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93302-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-635-3050
Provider Business Mailing Address Fax Number:
661-869-1503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 BRUNDAGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93304-3248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-323-6086
Provider Business Practice Location Address Fax Number:
661-324-6301
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEAVE
Authorized Official First Name:
OLGA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
661-635-3050

Provider Taxonomy Codes

  • Taxonomy code: 261QF0050X , with the licence number:  120000198 , 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: FHC11656G . This is a "FQHC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HAP11656G . This is a "FAMILY PACT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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