Provider Demographics
NPI:1386705390
Name:SIERRA PROVIDENCE HEALTH NETWORK
Entity type:Organization
Organization Name:SIERRA PROVIDENCE HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE AIDE
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GAMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-231-6628
Mailing Address - Street 1:81 CAMILLE APT 44
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-0011
Mailing Address - Country:US
Mailing Address - Phone:915-231-6628
Mailing Address - Fax:
Practice Address - Street 1:81 CAMILLE APT 44
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-0011
Practice Address - Country:US
Practice Address - Phone:915-231-6628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA08361345273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit