Provider Demographics
NPI:1245234673
Name:CLINICA SIERRA VISTA
Entity Type:Organization
Organization Name:CLINICA SIERRA VISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-635-3050
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:1430 TRUXTUN AVE
Practice Address - Street 2:STE 400
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5220
Practice Address - Country:US
Practice Address - Phone:661-635-3050
Practice Address - Fax:661-869-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR 0053190Medicaid
CAGR 0053150Medicaid
CAZZZ 14429ZMedicare ID - Type UnspecifiedMF CHC
CAZZZ 16928ZMedicare ID - Type UnspecifiedARVIN CHC
CAZZZ 79518ZMedicare ID - Type UnspecifiedFM CHC
CAZZZ 018412Medicare ID - Type UnspecifiedKV CHC
CAZZZ 14425ZMedicare ID - Type UnspecifiedDEL CHC
CAZZZ 14423ZMedicare ID - Type UnspecifiedCA CHC
CAZZZ 24162ZMedicare ID - Type UnspecifiedSB CHC
CAZZZ 31044ZMedicare ID - Type UnspecifiedNB CHC
CAZZZ 74503ZMedicare ID - Type UnspecifiedLA CHC
CAZZZ 91398ZMedicare ID - Type UnspecifiedKR CHC
CAGR 0053150Medicaid
CAZZZ 14430ZMedicare ID - Type Unspecified34TH CHC
CAZZZ 94404ZMedicare ID - Type UnspecifiedEB CHC
CAGR 0053190Medicaid