Healthcare Provider Details

I. General information

NPI: 1063693349
Provider Name (Legal Business Name): SIERRA JOINT COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 07/21/2022
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5726
US

IV. Provider business mailing address

250 SIERRA COLLEGE DR HEALTH CENTER
GRASS VALLEY CA
95945-5726
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-5317
  • Fax: 530-274-5347
Mailing address:
  • Phone: 530-274-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: WENDE D. FORTNER
Title or Position: COORDINATOR, HEALTH SERVICES
Credential: FNP
Phone: 916-660-7491