Provider Demographics
NPI:1487967303
Name:SIERRA ORTHOPEDIC INSTITUTE MEDICAL CORPORATION
Entity type:Organization
Organization Name:SIERRA ORTHOPEDIC INSTITUTE MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-533-5371
Mailing Address - Street 1:13949 MONO WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-2807
Mailing Address - Country:US
Mailing Address - Phone:209-629-0077
Mailing Address - Fax:
Practice Address - Street 1:13949 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2807
Practice Address - Country:US
Practice Address - Phone:209-533-5371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10879207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PTAN 1778Medicare UPIN