Healthcare Provider Details

I. General information

NPI: 1801502679
Provider Name (Legal Business Name): SIERRA MEDICAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 SARATOGA WAY STE 110
EL DORADO HILLS CA
95762-4590
US

IV. Provider business mailing address

1625 CREEKSIDE DR STE 202
FOLSOM CA
95630-3819
US

V. Phone/Fax

Practice location:
  • Phone: 916-365-9560
  • Fax:
Mailing address:
  • Phone: 916-663-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARC CABANNE
Title or Position: CREDENTIALING
Credential:
Phone: 916-663-2100