Healthcare Provider Details

I. General information

NPI: 1154148062
Provider Name (Legal Business Name): SIERRA FAMILY PRACTICE PARTNERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 10/22/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41837 SIERRA DRIVE
THREE RIVERS CA
93271-9712
US

IV. Provider business mailing address

41837 SIERRA DRIVE
THREE RIVERS CA
93271-9712
US

V. Phone/Fax

Practice location:
  • Phone: 310-923-4392
  • Fax:
Mailing address:
  • Phone: 559-566-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MERTZ
Title or Position: PRESIDENT
Credential:
Phone: 310-923-4392