MEDICARE: SIERRA VIEW NEPHROLOGY, INC

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	207R00000X	Internal Medicine Physician	C52775	CA
2	207RN0300X	Nephrology Physician	C52775	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ50981Z	OTHER	CA	BLUE SHIELD PIN

General Provider Information

NPI Number	:	1689888109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA VIEW NEPHROLOGY, INC

Provider Business Mailing Address
First Line	:	557 W MORTON AVE
Second Line	:	SUITE A
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-3333
Country	:	US
Telephone Number	:	559-784-4925
Fax Number	:	559-784-4966

Provider Business Practice Location Address
First Line	:	557 W MORTON AVE
Second Line	:	SUITE A
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-3333
Country	:	US
Telephone Number	:	559-784-4925
Fax Number	:	559-784-4966

Authorized Official
Title or Position	:	OWNER
Name	:	NIRUPAMA VEMURI
Credential	:	MD
Telephone Number	:	559-784-4925

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	09/11/2012

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Directions to “SIERRA VIEW NEPHROLOGY, INC ” Practice Location

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