Provider Demographics
NPI:1154148062
Name:SIERRA FAMILY PRACTICE PARTNERS PC
Entity type:Organization
Organization Name:SIERRA FAMILY PRACTICE PARTNERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-923-4392
Mailing Address - Street 1:41837 SIERRA DRIVE
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:CA
Mailing Address - Zip Code:93271-9712
Mailing Address - Country:US
Mailing Address - Phone:559-566-6311
Mailing Address - Fax:
Practice Address - Street 1:41837 SIERRA DRIVE
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:CA
Practice Address - Zip Code:93271-9712
Practice Address - Country:US
Practice Address - Phone:310-923-4392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty