Provider Demographics
NPI:1386856474
Name:SIERRA PRIMARY CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:SIERRA PRIMARY CARE MEDICAL GROUP
Other - Org Name:SIERRA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GABBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-945-9411
Mailing Address - Street 1:44469 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3324
Mailing Address - Country:US
Mailing Address - Phone:661-945-9411
Mailing Address - Fax:661-723-7170
Practice Address - Street 1:1037 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4745
Practice Address - Country:US
Practice Address - Phone:661-273-0100
Practice Address - Fax:661-273-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10061AMedicare ID - Type UnspecifiedPALMDALE GROUP ID#