Provider Demographics
NPI:1407163710
Name:SIERRA-PACIFIC TECHNOLOGY, INC.
Entity Type:Organization
Organization Name:SIERRA-PACIFIC TECHNOLOGY, INC.
Other - Org Name:SIERRA-PACIFIC HEALTH SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:UKPONG
Authorized Official - Middle Name:
Authorized Official - Last Name:UWEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-472-1136
Mailing Address - Street 1:P.O. BOX 77843
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-1143
Mailing Address - Country:US
Mailing Address - Phone:209-472-1136
Mailing Address - Fax:209-472-1138
Practice Address - Street 1:4873 WEST LN
Practice Address - Street 2:SUITE C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4548
Practice Address - Country:US
Practice Address - Phone:209-472-1136
Practice Address - Fax:209-472-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54805332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02917FMedicaid
CA6470950001Medicare NSC