Provider Demographics
NPI:1275552796
Name:SIERRA, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:SIERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4754 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1234
Mailing Address - Country:US
Mailing Address - Phone:323-909-0041
Mailing Address - Fax:323-909-0042
Practice Address - Street 1:4754 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1234
Practice Address - Country:US
Practice Address - Phone:323-909-0041
Practice Address - Fax:323-909-0042
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32593207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G325931Medicaid
CAG32593AOtherMEDICARE NUMBER
CAG32593AOtherMEDICARE NUMBER