Provider Demographics
NPI:1457353831
Name:CLINICA SIERRA VISTA
Entity Type:Organization
Organization Name:CLINICA SIERRA VISTA
Other - Org Name:FRAZIER MOUNTAIN COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
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:661-869-1503
Practice Address - Street 1:704 LEBEC RD
Practice Address - Street 2:
Practice Address - City:LEBEC
Practice Address - State:CA
Practice Address - Zip Code:93243
Practice Address - Country:US
Practice Address - Phone:661-248-5250
Practice Address - Fax:661-248-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000199261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12040FMedicaid
CAZZZ65152ZOtherBLUE SHIELD PIN
CAHAP12040FOtherFAMILY PACT
CABCP12040FOtherCDP
CAZZZ79518ZMedicare ID - Type UnspecifiedMEDICAR Z NUMBER
CA12040FMedicaid
CA051839Medicare Oscar/Certification