Provider Demographics
NPI:1467825844
Name:SUTTER VALLEY MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SUTTER VALLEY MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SH VP, QUALITY, SAFETY AND PATIENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-384-7544
Mailing Address - Street 1:2700 GATEWAY OAKS DR
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-4337
Mailing Address - Country:US
Mailing Address - Phone:209-524-1211
Mailing Address - Fax:
Practice Address - Street 1:8011 DON AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2841
Practice Address - Country:US
Practice Address - Phone:209-955-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA186794Medicare Oscar/Certification
CA05C0001888Medicare Oscar/Certification