Provider Demographics
NPI:1467506634
Name:SIERRA KINGS WOMEN'S HEALTH CENTER, INC. A CALIFORNIA PROFESSIONAL MED
Entity Type:Organization
Organization Name:SIERRA KINGS WOMEN'S HEALTH CENTER, INC. A CALIFORNIA PROFESSIONAL MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-493-5307
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-0151
Mailing Address - Country:US
Mailing Address - Phone:559-493-5307
Mailing Address - Fax:559-553-6269
Practice Address - Street 1:372 W CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2113
Practice Address - Country:US
Practice Address - Phone:559-493-5307
Practice Address - Fax:559-553-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75797207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085541Medicaid
CAGR0085540Medicaid
CAGR0085540Medicaid