MEDICARE: SIERRA PLASTIC SURGERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician		NV

General Provider Information

NPI Number	:	1538157169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA PLASTIC SURGERY LLC

Provider Business Mailing Address
First Line	:	904 N NEVADA ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-3934
Country	:	US
Telephone Number	:	775-841-9090
Fax Number	:	775-841-9091

Provider Business Practice Location Address
First Line	:	904 N NEVADA ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-3934
Country	:	US
Telephone Number	:	775-841-9090
Fax Number	:	757-841-9091

Authorized Official
Title or Position	:	CEO
Name	:	BORIS VOLSHTEYN
Credential	:	MD
Telephone Number	:	775-841-9090

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/21/2022

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