Provider Demographics
NPI:1538330998
Name:PACIFIC SIERRA MEDICAL
Entity Type:Organization
Organization Name:PACIFIC SIERRA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FOLUKE
Authorized Official - Middle Name:YETUNDE
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MBA
Authorized Official - Phone:858-568-3454
Mailing Address - Street 1:1130 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3209
Mailing Address - Country:US
Mailing Address - Phone:858-568-3454
Mailing Address - Fax:
Practice Address - Street 1:14456 KENTFIELD PL
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-3360
Practice Address - Country:US
Practice Address - Phone:858-568-3454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies