Healthcare Provider Details

I. General information

NPI: 1740422286
Provider Name (Legal Business Name): SUTTER VALLEY MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16911 WILLOW GLEN ROAD
BROWNSVILLE CA
95919
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 530-675-2457
  • Fax: 530-675-0530
Mailing address:
  • Phone: 916-854-6975
  • Fax: 916-854-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0617902
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number230000331
License Number StateCA

VIII. Authorized Official

Name: KRISTA LOPES
Title or Position: SH VP, QUALITY, SAFETY AND PATIENT
Credential:
Phone: 916-384-7544