Provider Demographics
NPI:1548564735
Name:SIERRA RHEUMATOLOGY INC, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SIERRA RHEUMATOLOGY INC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUPAMA
Authorized Official - Middle Name:SAVITHRI
Authorized Official - Last Name:BHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-677-4744
Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2924
Mailing Address - Country:US
Mailing Address - Phone:916-677-4744
Mailing Address - Fax:916-781-2029
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 1201
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-677-4744
Practice Address - Fax:916-781-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-02
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97133207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DJ248AMedicare PIN