Healthcare Provider Details

I. General information

NPI: 1801827555
Provider Name (Legal Business Name): SIERRA HOUSECALLS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 FAIRVIEW LN SUITE C
SONORA CA
95370-4856
US

IV. Provider business mailing address

183 FAIRVIEW LN SUITE C
SONORA CA
95370-4856
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-4287
  • Fax:
Mailing address:
  • Phone: 209-532-4287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW L PERSONIUS
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 209-532-4287