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General NPI Number Information
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NPI Number | 1235145608
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Entity Type | Organization
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Legal Business Name | SIERRA NEVADA PRIMARY CARE
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 140 LITTON DR STE 120
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5080
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Country | US
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Telephone | 530-272-9770
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Fax | 530-272-9796
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Provider Business Mailing Address
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Address Line | PO BOX 459001
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City | GRASS VALLEY
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State | CA
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Zip | 95945-9101
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Country | US
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Telephone | 530-272-9770
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Fax | 530-272-9796
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Authorized Official
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Title or Position | DO
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Name | MARA BEREZNIAK
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Credential | DO
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Telephone | 530-432-7023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G35403
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G237680
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A26753
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G34453
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A71856
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G61414
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License Number State | CA
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