Provider Demographics
NPI:1992829758
Name:CLINICA SIERRA VISTA
Entity Type:Organization
Organization Name:CLINICA SIERRA VISTA
Other - Org Name:KERN RIVER HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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 1:67 EVANS ROAD
Practice Address - Street 2:
Practice Address - City:WOFFORD HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:93285
Practice Address - Country:US
Practice Address - Phone:760-376-2276
Practice Address - Fax:760-376-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000201261QM2500X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP03896FOtherMEDICAL SPECIALTY
CAFHC03896FOtherMEDICAL SPECIALTY