Provider Demographics
NPI:1710134093
Name:SIERRA WOMENS HEALTH ASSOCIATES INC
Entity Type:Organization
Organization Name:SIERRA WOMENS HEALTH ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-273-8486
Mailing Address - Street 1:280 SIERRA COLLEGE DRIVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5763
Mailing Address - Country:US
Mailing Address - Phone:530-273-8486
Mailing Address - Fax:530-271-0505
Practice Address - Street 1:280 SIERRA COLLEGE DRIVE
Practice Address - Street 2:SUITE 125
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-273-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP37780207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3101935OtherCALIFORNIA CORPORATION NUMBER
CASIE0119OtherCITY OF GRASS VALLEY BUSINESS LICENSE