1336500438 NPI number — SIERRA PACIFIC NEUROSURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL CORP

Table of content: (NPI 1336500438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336500438 NPI number — SIERRA PACIFIC NEUROSURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA PACIFIC NEUROSURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL CORP
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:
1336500438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7255 N CEDAR AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-525-9088
Provider Business Mailing Address Fax Number:
559-478-4463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7255 N CEDAR AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-525-9088
Provider Business Practice Location Address Fax Number:
559-478-4463
Provider Enumeration Date:
03/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
559-525-9088

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  G86263 , 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)





Copyright © 2007-2025 www.npivalidator.com