Healthcare Provider Details

I. General information

NPI: 1477900835
Provider Name (Legal Business Name): WESTERN SIERRA HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 OLD TUNNEL RD
GRASS VALLEY CA
95945-8524
US

IV. Provider business mailing address

844 OLD TUNNEL RD
GRASS VALLEY CA
95945-8524
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-9762
  • Fax: 530-273-7255
Mailing address:
  • Phone: 530-274-9762
  • Fax: 530-273-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number22952
License Number StateCA

VIII. Authorized Official

Name: MS. MELISSA DILLON
Title or Position: OFFICE MANAGER
Credential:
Phone: 530-274-9762