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General NPI Number Information
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NPI Number | 1013475755
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Entity Type | Organization
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Legal Business Name | SIERRA ORTHOPEDIC INSTITUTE MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 13949 MONO WAY
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City | SONORA
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State | CA
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Zip | 95370-2807
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Country | US
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Telephone | 209-728-5035
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Fax |
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Provider Business Mailing Address
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Address Line | 13205 SYLVA LN
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City | SONORA
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State | CA
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Zip | 95370-5286
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Country | US
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Telephone | 209-728-5035
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARIANA MARIE DEMERS
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Credential | DO
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Telephone | 209-728-5035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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