Provider Demographics
NPI:1326249178
Name:SIERRA MEDICAL CENTER GROUP INC
Entity Type:Organization
Organization Name:SIERRA MEDICAL CENTER GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-598-6638
Mailing Address - Street 1:10621 N KENDALL DR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1530
Mailing Address - Country:US
Mailing Address - Phone:305-598-6628
Mailing Address - Fax:305-598-6638
Practice Address - Street 1:10621 N KENDALL DR
Practice Address - Street 2:SUITE 213
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1530
Practice Address - Country:US
Practice Address - Phone:305-598-6628
Practice Address - Fax:305-598-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82104173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty