Healthcare Provider Details

I. General information

NPI: 1669180659
Provider Name (Legal Business Name): SIERRA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5824 S DURANGO DR STE 130
LAS VEGAS NV
89113-2314
US

IV. Provider business mailing address

870 SEVEN HILLS DR STE 101
HENDERSON NV
89052-4378
US

V. Phone/Fax

Practice location:
  • Phone: 702-340-9994
  • Fax:
Mailing address:
  • Phone: 702-340-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: OLIVIA SANTIAGO
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-780-4327