Provider Demographics
NPI:1962768523
Name:SIERRA ACCIDENT AND INJURY REHABILITATION P.C.
Entity type:Organization
Organization Name:SIERRA ACCIDENT AND INJURY REHABILITATION P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-648-2700
Mailing Address - Street 1:1001 SE TUALATIN VALLEY HWY STE A29
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5022
Mailing Address - Country:US
Mailing Address - Phone:503-648-2700
Mailing Address - Fax:
Practice Address - Street 1:1001 SE TUALATIN VALLEY HWY STE A29
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-5022
Practice Address - Country:US
Practice Address - Phone:503-648-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3613111N00000X
OR3959111N00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty