Healthcare Provider Details

I. General information

NPI: 1528336351
Provider Name (Legal Business Name): CLINICA SIERRA VISTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4739 W SHAW AVE STE 108
FRESNO CA
93722-6265
US

IV. Provider business mailing address

PO BOX 1559
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 661-635-3050
  • Fax: 661-869-1503
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-732-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. OLGA MEAVE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 661-635-3050