Provider Demographics
NPI:1083830962
Name:SIERRA GASTROENTEROLOGY
Entity Type:Organization
Organization Name:SIERRA GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-348-0500
Mailing Address - Street 1:44725 10TH ST W
Mailing Address - Street 2:STE 250
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44725 10TH ST W
Practice Address - Street 2:STE 250
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3033
Practice Address - Country:US
Practice Address - Phone:310-348-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0024400Medicaid
CAGR0024400Medicaid