Provider Demographics
NPI:1336500438
Name:SIERRA PACIFIC NEUROSURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:SIERRA PACIFIC NEUROSURGICAL ASSOCIATES, A PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-525-9088
Mailing Address - Street 1:7255 N CEDAR AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3831
Mailing Address - Country:US
Mailing Address - Phone:559-525-9088
Mailing Address - Fax:559-478-4463
Practice Address - Street 1:7255 N CEDAR AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3831
Practice Address - Country:US
Practice Address - Phone:559-525-9088
Practice Address - Fax:559-478-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86263207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty