Healthcare Provider Details

I. General information

NPI: 1215225982
Provider Name (Legal Business Name): SIERRA SPECIALTY CALL GROUP MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 GUZZI LN SUITE 203
SONORA CA
95370-5288
US

IV. Provider business mailing address

680 GUZZI LN SUITE 203
SONORA CA
95370-5288
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-5244
  • Fax: 209-532-5247
Mailing address:
  • Phone: 209-532-5244
  • Fax: 209-532-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A10879
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA88661
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC37479
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA45369
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA53424
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA50509
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA45369
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ERIC R FREEDMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-532-5244