Healthcare Provider Details

I. General information

NPI: 1427072008
Provider Name (Legal Business Name): SIERRA NEVADA PRIMARY CARE PHYSICIANS A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 LITTON DR STE 100
GRASS VALLEY CA
95945-5078
US

IV. Provider business mailing address

PO BOX 459001
GRASS VALLEY CA
95945-9101
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-4016
  • Fax: 530-477-4018
Mailing address:
  • Phone: 530-272-9788
  • Fax: 530-272-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1730163791
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC52481
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7940
License Number StateCA

VIII. Authorized Official

Name: MARA BEREZNIAK
Title or Position: DO
Credential: DO
Phone: 530-432-7023