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General NPI Number Information
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NPI Number | 1861867855
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Entity Type | Organization
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Legal Business Name | SIERRA PACIFIC SURGICAL, INC.
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 584 N SUNRISE AVE STE 100
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City | ROSEVILLE
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State | CA
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Zip | 95661-2862
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Country | US
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Telephone | 916-250-2596
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Fax | 916-550-5025
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Provider Business Mailing Address
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Address Line | 2001 RATTLESNAKE RD
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City | NEWCASTLE
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State | CA
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Zip | 95658-9722
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Country | US
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Telephone | 916-663-2100
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Fax | 916-663-2103
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Authorized Official
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Title or Position | OWNER
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Name | DAVID MICHAEL SKEEHAN
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Credential | DO
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Telephone | 916-250-2596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20A10739
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License Number State | CA
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