Provider Demographics
NPI:1255706289
Name:SIERRA FUNCTIONAL MEDICAL PC
Entity type:Organization
Organization Name:SIERRA FUNCTIONAL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:U
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:559-297-0030
Mailing Address - Street 1:2147 HERNDON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6305
Mailing Address - Country:US
Mailing Address - Phone:559-297-0030
Mailing Address - Fax:559-297-7888
Practice Address - Street 1:2181 HERNDON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6309
Practice Address - Country:US
Practice Address - Phone:559-297-0030
Practice Address - Fax:559-297-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty