Provider Demographics
NPI:1558486597
Name:CLINICA SIERRA VISTA
Entity Type:Organization
Organization Name:CLINICA SIERRA VISTA
Other - Org Name:EAST BAKERSFIELD COMMUNITY HEALTH CENTER - MEDICAL GROUP HOSPITAL NPI
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-635-3050
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-732-3064
Practice Address - Street 1:815 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-1365
Practice Address - Country:US
Practice Address - Phone:661-322-3905
Practice Address - Fax:661-322-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X, 282N00000X
CA120000205261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR# 0053150OtherMULTI-SPECIALTY
CAFHC70285FOtherFQHC