Healthcare Provider Details

I. General information

NPI: 1306304472
Provider Name (Legal Business Name): THAIS SIERRA PACIFIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 US HIGHWAY 395 N
GARDNERVILLE NV
89410-5304
US

IV. Provider business mailing address

PO BOX 18228
RENO NV
89511-0228
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WARREN THAI
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 775-313-8926