Healthcare Provider Details

I. General information

NPI: 1184072985
Provider Name (Legal Business Name): SIERRA VANOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554-850 MEDICAL CENTER DR.
BIEBER CA
96009
US

IV. Provider business mailing address

40847 BROWN RD
FALL RIVER MILLS CA
96028-9700
US

V. Phone/Fax

Practice location:
  • Phone: 530-294-5629
  • Fax:
Mailing address:
  • Phone: 530-336-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number25213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: