Provider Demographics
NPI:1023283504
Name:SEIRRA HEALTH CENTER
Entity type:Organization
Organization Name:SEIRRA HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANEETA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-526-5770
Mailing Address - Street 1:1801 TULLY RD STE F
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2931
Mailing Address - Country:US
Mailing Address - Phone:209-526-5770
Mailing Address - Fax:209-544-1234
Practice Address - Street 1:1801 TULLY RD
Practice Address - Street 2:SUIT F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2931
Practice Address - Country:US
Practice Address - Phone:209-526-5770
Practice Address - Fax:209-544-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12831OtherPA12831