MEDICARE: SIERRA FAMILY PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1861222382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA FAMILY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	4297 N SIERRA WAY
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-3820
Country	:	US
Telephone Number	:	909-300-0901
Fax Number	:

Provider Business Practice Location Address
First Line	:	4297 N SIERRA WAY
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-3820
Country	:	US
Telephone Number	:	909-300-0901
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DORINA CASTELO
Credential	:	MD
Telephone Number	:	951-245-0505

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/08/2024

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Directions to “SIERRA FAMILY PROFESSIONAL CORPORATION ” Practice Location

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